Provider Demographics
NPI:1285865519
Name:WOODALL, ALISHA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:WOODALL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 N ZANG BLVD
Mailing Address - Street 2:1132
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1409 N ZANG BLVD
Practice Address - Street 2:1132
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1202
Practice Address - Country:US
Practice Address - Phone:214-782-9031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional