Provider Demographics
NPI:1013216001
Name:WARREN, ALYSHA B (LCPC)
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:B
Last Name:WARREN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10031 OLD OCEAN CITY BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-1172
Mailing Address - Country:US
Mailing Address - Phone:410-641-3121
Mailing Address - Fax:
Practice Address - Street 1:10031 OLD OCEAN CITY BLVD STE 106
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1172
Practice Address - Country:US
Practice Address - Phone:410-641-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional