Healthcare Provider Details

I. General information

NPI: 1598292112
Provider Name (Legal Business Name): ALISHA MASSEY DALTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2017
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17542 FIVE OAKS DR
BATON ROUGE LA
70810-6553
US

IV. Provider business mailing address

17542 FIVE OAKS DR
BATON ROUGE LA
70810-6553
US

V. Phone/Fax

Practice location:
  • Phone: 225-620-7799
  • Fax:
Mailing address:
  • Phone: 225-620-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90383
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTPMC5003
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3039
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-GA-1715
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-OH-1716
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6370
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: