Provider Demographics
NPI:1811629199
Name:HAGSTROM, ALICIA (LPC-MH, LAC)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:HAGSTROM
Suffix:
Gender:F
Credentials:LPC-MH, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 S MINNESOTA AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2700
Mailing Address - Country:US
Mailing Address - Phone:605-231-8387
Mailing Address - Fax:
Practice Address - Street 1:5000 S MINNESOTA AVE STE 300
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2700
Practice Address - Country:US
Practice Address - Phone:605-231-8387
Practice Address - Fax:833-354-8222
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)