Provider Demographics
NPI:1114030822
Name:MOORE, ALISHA MARIE (LPCC)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:FLESHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:ASHLAND
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:3701 LANSDOWNE DRIVE
Practice Address - Street 2:ASHLAND
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102
Practice Address - Country:US
Practice Address - Phone:606-324-3005
Practice Address - Fax:606-329-1530
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105832101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
11754980OtherCAQH
000000321261OtherANTHEM BCBS
KY7100283580Medicaid
11754980OtherCAQH