Provider Demographics
NPI:1891267787
Name:DORN, ALICIA (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:DORN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DOWLING CIR APT T1
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6643
Mailing Address - Country:US
Mailing Address - Phone:443-977-4885
Mailing Address - Fax:
Practice Address - Street 1:2700 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-3115
Practice Address - Country:US
Practice Address - Phone:600-667-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC8143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional