Provider Demographics
NPI:1790093649
Name:ALICEA, ANEECE LIN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ANEECE
Middle Name:LIN
Last Name:ALICEA
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611A CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6111
Mailing Address - Country:US
Mailing Address - Phone:219-462-6705
Mailing Address - Fax:219-464-4318
Practice Address - Street 1:2611A CHICAGO ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-6111
Practice Address - Country:US
Practice Address - Phone:219-462-6705
Practice Address - Fax:219-464-4318
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002192A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health