Provider Demographics
NPI:1881776037
Name:PLACKETT, ALISA POTTS (LPC)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:POTTS
Last Name:PLACKETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 KEMPSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4727
Mailing Address - Country:US
Mailing Address - Phone:757-455-6207
Mailing Address - Fax:757-466-0767
Practice Address - Street 1:443 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4727
Practice Address - Country:US
Practice Address - Phone:757-455-6207
Practice Address - Fax:757-466-0767
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional