Provider Demographics
NPI:1629731575
Name:DAMGARD, ALICIA (LLPC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:DAMGARD
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N MITCHELL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-1859
Mailing Address - Country:US
Mailing Address - Phone:231-884-0028
Mailing Address - Fax:
Practice Address - Street 1:201 N MITCHELL ST STE 204
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-1859
Practice Address - Country:US
Practice Address - Phone:231-884-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451018455101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty