Provider Demographics
NPI:1457451114
Name:CARR, ALISA MONIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:MONIQUE
Last Name:CARR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6204 SOFTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-4524
Mailing Address - Country:US
Mailing Address - Phone:512-297-8717
Mailing Address - Fax:888-395-2986
Practice Address - Street 1:4403 MANCHACA RD
Practice Address - Street 2:SUITE D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1680
Practice Address - Country:US
Practice Address - Phone:512-297-8717
Practice Address - Fax:888-395-2986
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB152569OtherMEDICARE PTAN