Provider Demographics
NPI:1346590213
Name:PRICE, ALISA SPANN (LPC)
Entity Type:Individual
Prefix:MS
First Name:ALISA
Middle Name:SPANN
Last Name:PRICE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1120 W BROAD AVE
Mailing Address - Street 2:SUITE C-6
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-4397
Mailing Address - Country:US
Mailing Address - Phone:229-430-0416
Mailing Address - Fax:229-430-6002
Practice Address - Street 1:12799 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-2315
Practice Address - Country:US
Practice Address - Phone:229-430-0416
Practice Address - Fax:229-430-6200
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006733101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional