Healthcare Provider Details

I. General information

NPI: 1114030822
Provider Name (Legal Business Name): ALISHA MARIE MOORE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISHA FLESHER

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LANSDOWNE DRIVE ASHLAND
ASHLAND KY
41102
US

IV. Provider business mailing address

PO BOX 790 ASHLAND
ASHLAND KY
41105-0790
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-3005
  • Fax: 606-329-1530
Mailing address:
  • Phone: 606-329-8588
  • Fax: 606-329-8195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number105832
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: