Provider Demographics
NPI:1285826842
Name:WOHLGEMUTH, ALICE BORDEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:BORDEN
Last Name:WOHLGEMUTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MOHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1827
Mailing Address - Country:US
Mailing Address - Phone:973-586-4155
Mailing Address - Fax:
Practice Address - Street 1:20 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-1827
Practice Address - Country:US
Practice Address - Phone:973-586-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00078200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional