Healthcare Provider Details

I. General information

NPI: 1629731575
Provider Name (Legal Business Name): ALICIA DAMGARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N MAIN ST
LAKE CITY MI
49651-5103
US

IV. Provider business mailing address

150 HUNTERS RDG
CADILLAC MI
49601-8006
US

V. Phone/Fax

Practice location:
  • Phone: 231-295-1196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401223166
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401223166
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: