Provider Demographics
NPI:1407252513
Name:DOTSON, ALICIA KAE (LMHC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:KAE
Last Name:DOTSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 45TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50311-3413
Mailing Address - Country:US
Mailing Address - Phone:641-740-1384
Mailing Address - Fax:
Practice Address - Street 1:1308 8TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2649
Practice Address - Country:US
Practice Address - Phone:515-276-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health