Provider Demographics
NPI:1811328172
Name:ZACHERY, ALISA (LCSW)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:ZACHERY
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 1:10800 GOSLING RD UNIT 130142
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-4008
Mailing Address - Country:US
Mailing Address - Phone:510-686-3446
Mailing Address - Fax:832-202-1360
Practice Address - Street 1:10800 GOSLING RD UNIT 130142
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77393-4008
Practice Address - Country:US
Practice Address - Phone:510-686-3446
Practice Address - Fax:832-202-1360
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671681041C0700X
LA123661041C0700X
CA960471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical