Healthcare Provider Details

I. General information

NPI: 1780188805
Provider Name (Legal Business Name): ALISHA LESTER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISHA MACK

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 MAIN ST N
PEARSON GA
31642-7549
US

IV. Provider business mailing address

204 E 4TH ST
OCILLA GA
31774-1539
US

V. Phone/Fax

Practice location:
  • Phone: 912-544-4569
  • Fax: 229-468-9169
Mailing address:
  • Phone: 229-468-9166
  • Fax: 229-468-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC008272
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: