Provider Demographics
NPI:1417646118
Name:SANTUCCI, ALISA (LCMFT)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:SANTUCCI
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14060 JUMP DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6177
Mailing Address - Country:US
Mailing Address - Phone:240-476-0353
Mailing Address - Fax:
Practice Address - Street 1:14060 JUMP DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-6177
Practice Address - Country:US
Practice Address - Phone:240-476-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health