Provider Demographics
NPI:1285807263
Name:STELLWAGEN, ALICIA DAWN (LPC, NCC, MAC, AADC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:DAWN
Last Name:STELLWAGEN
Suffix:
Gender:F
Credentials:LPC, NCC, MAC, AADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SHENANDOAH DR
Mailing Address - Street 2:
Mailing Address - City:DAVISVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26142-1003
Mailing Address - Country:US
Mailing Address - Phone:304-488-7898
Mailing Address - Fax:
Practice Address - Street 1:47 SHENANDOAH DR
Practice Address - Street 2:
Practice Address - City:DAVISVILLE
Practice Address - State:WV
Practice Address - Zip Code:26142-1003
Practice Address - Country:US
Practice Address - Phone:304-488-7898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
301125101Y00000X
WV10-302101YA0400X
509209101YA0400X
WV1951101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)