Provider Demographics
NPI:1598292112
Name:DALTON, ALISHA MASSEY
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:MASSEY
Last Name:DALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77497-0030
Mailing Address - Country:US
Mailing Address - Phone:225-620-7799
Mailing Address - Fax:
Practice Address - Street 1:2440 TEXAS PKWY STE 340E
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4231
Practice Address - Country:US
Practice Address - Phone:225-620-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-13
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional