Provider Demographics
NPI:1437677051
Name:GERSTNER, ALICIA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:GERSTNER
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 1:128 ALVINA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2444
Mailing Address - Country:US
Mailing Address - Phone:906-280-1990
Mailing Address - Fax:
Practice Address - Street 1:3431 COMMODITY LN
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5688
Practice Address - Country:US
Practice Address - Phone:800-222-8590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI873703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health