Provider Demographics
NPI:1609910140
Name:MINDLIN, ALICIA CAROL (PSYD, LPC)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:CAROL
Last Name:MINDLIN
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W MAPLE RD STE D410
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3711
Mailing Address - Country:US
Mailing Address - Phone:248-496-8078
Mailing Address - Fax:
Practice Address - Street 1:5600 W MAPLE RD STE D410
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3711
Practice Address - Country:US
Practice Address - Phone:248-496-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009493101YM0800X
MI6301014314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health