Provider Demographics
NPI:1790983013
Name:WARD, ALISHA RENEE (MED, TCADC)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:RENEE
Last Name:WARD
Suffix:
Gender:F
Credentials:MED, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 AIRES CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2455
Mailing Address - Country:US
Mailing Address - Phone:502-265-6086
Mailing Address - Fax:
Practice Address - Street 1:1115 GARVIN PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-3178
Practice Address - Country:US
Practice Address - Phone:502-416-8783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-08
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277684101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)