Provider Demographics
NPI:1184430779
Name:GAUTHIER, ALEICE WILMORE (LMSW)
Entity type:Individual
Prefix:
First Name:ALEICE
Middle Name:WILMORE
Last Name:GAUTHIER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CALDWELL CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7387
Mailing Address - Country:US
Mailing Address - Phone:318-794-1766
Mailing Address - Fax:
Practice Address - Street 1:100 SABAL PALMS ROW STE 1
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-6754
Practice Address - Country:US
Practice Address - Phone:318-794-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health