Provider Demographics
NPI:1811248974
Name:WATT, ALICIA M (LPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:WATT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7127 E ATHERTON RD
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2403
Mailing Address - Country:US
Mailing Address - Phone:810-338-6655
Mailing Address - Fax:248-856-4568
Practice Address - Street 1:7300 DIXIE HWY STE 1000
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5105
Practice Address - Country:US
Practice Address - Phone:248-922-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013457101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional