Provider Demographics
NPI:1255012704
Name:HENDRIX, ALISA NICOLE
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:NICOLE
Last Name:HENDRIX
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 1:5495 CEDAR LN APT 209
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1307
Mailing Address - Country:US
Mailing Address - Phone:667-200-9906
Mailing Address - Fax:
Practice Address - Street 1:5495 CEDAR LN APT 209
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1307
Practice Address - Country:US
Practice Address - Phone:667-200-9906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician