Provider Demographics
NPI:1053003467
Name:MIDDLETON, ALECIA (EDD, LPC)
Entity type:Individual
Prefix:DR
First Name:ALECIA
Middle Name:
Last Name:MIDDLETON
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45845 WILDRYE CT
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-6405
Mailing Address - Country:US
Mailing Address - Phone:313-506-7379
Mailing Address - Fax:
Practice Address - Street 1:45845 WILDRYE CT
Practice Address - Street 2:
Practice Address - City:VAN BUREN TWP
Practice Address - State:MI
Practice Address - Zip Code:48111-6405
Practice Address - Country:US
Practice Address - Phone:313-506-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223093101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional