Healthcare Provider Details

I. General information

NPI: 1891267787
Provider Name (Legal Business Name): ALICIA DORN LCPC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 09/11/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10621 165TH ST W
LAKEVILLE MN
55044-3520
US

IV. Provider business mailing address

7201 METRO BLVD STE 550
MINNEAPOLIS MN
55439-1353
US

V. Phone/Fax

Practice location:
  • Phone: 763-210-9966
  • Fax:
Mailing address:
  • Phone: 443-977-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC8143
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: