Provider Demographics
NPI:1245474642
Name:LEWIS, ALISHA (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MISS
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:DURHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:1302 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-4117
Mailing Address - Country:US
Mailing Address - Phone:334-677-7856
Mailing Address - Fax:334-678-2642
Practice Address - Street 1:1302 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-4117
Practice Address - Country:US
Practice Address - Phone:334-677-7856
Practice Address - Fax:334-678-2642
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1607101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional