Provider Demographics
NPI:1962918615
Name:WEISENSEL, ALICIA MARIE (MS, LLP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIE
Last Name:WEISENSEL
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9258 ABBEY LN
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-9414
Mailing Address - Country:US
Mailing Address - Phone:781-799-0968
Mailing Address - Fax:
Practice Address - Street 1:27780 NOVI RD STE 107
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-3427
Practice Address - Country:US
Practice Address - Phone:781-799-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015544103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical