Healthcare Provider Details

I. General information

NPI: 1891298113
Provider Name (Legal Business Name): ALISHA WEATHERLY-KERSHAW PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE
FORT STEWART GA
31314-5641
US

IV. Provider business mailing address

1061 HARMON AVE
FORT STEWART GA
31314-5641
US

V. Phone/Fax

Practice location:
  • Phone: 571-801-0731
  • Fax:
Mailing address:
  • Phone: 571-801-0731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810008835
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: