Healthcare Provider Details

I. General information

NPI: 1366087520
Provider Name (Legal Business Name): ALICIA MICHELLE KILBOURN MA, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA WATTS

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 AXTELL DR STE 100
TROY MI
48084-4400
US

IV. Provider business mailing address

6549 TOWN CENTER DR STE A
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 248-613-5377
  • Fax:
Mailing address:
  • Phone: 800-395-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401222303
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017896
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: