Provider Demographics
NPI:1861844995
Name:DRAKE, ALISA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:
Last Name:DRAKE
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 1:610 CLIPPER SHIP CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3622
Mailing Address - Country:US
Mailing Address - Phone:907-301-3199
Mailing Address - Fax:
Practice Address - Street 1:610 CLIPPER SHIP CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3622
Practice Address - Country:US
Practice Address - Phone:907-301-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK901101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional