Provider Demographics
NPI:1962196501
Name:GAST, ALIVIA PAIGE
Entity type:Individual
Prefix:
First Name:ALIVIA
Middle Name:PAIGE
Last Name:GAST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 PROVIDENCE COVE CT
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9148
Mailing Address - Country:US
Mailing Address - Phone:616-419-7164
Mailing Address - Fax:
Practice Address - Street 1:1482 PROVIDENCE COVE CT
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9148
Practice Address - Country:US
Practice Address - Phone:616-419-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker