Provider Demographics
NPI:1740213933
Name:LASEK, ALICE PAIGE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:PAIGE
Last Name:LASEK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 WESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-8111
Mailing Address - Country:US
Mailing Address - Phone:843-236-2006
Mailing Address - Fax:
Practice Address - Street 1:1335 44TH AVE N
Practice Address - Street 2:EXECUTIVE CENTER - SUITE 204
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5980
Practice Address - Country:US
Practice Address - Phone:843-907-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC5367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor