Basic Information
| Provider Information | |||||||||
| NPI: | 1245768522 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOOLIN | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | LMHC, LCAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1040 SIERRA DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461437241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178658797 | ||||||||
| FaxNumber: | 3178598552 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 JOLIET ST | ||||||||
| Address2: | |||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463111705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2193225747 | ||||||||
| FaxNumber: | 2198642282 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2017 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 39000972A | IN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 87000264A | 01 | IN | STATE LICENSING BOARD | OTHER | 300007506 | 05 | IN | MEDICAID | 39000972A | 01 | IN | STATE LICENSING BOARD | OTHER |