Provider Demographics
NPI:1891925749
Name:ZIMMERMAN, ALISHIA SHIFFON (LCPC)
Entity Type:Individual
Prefix:
First Name:ALISHIA
Middle Name:SHIFFON
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 RIGA ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3637
Mailing Address - Country:US
Mailing Address - Phone:301-728-2888
Mailing Address - Fax:
Practice Address - Street 1:9135 PISCATAWAY RD
Practice Address - Street 2:SUITE 340
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2549
Practice Address - Country:US
Practice Address - Phone:240-696-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3205101YP2500X
VA0701005955101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD024017600Medicaid