Healthcare Provider Details

I. General information

NPI: 1588230957
Provider Name (Legal Business Name): MISS ALISSA SHENEA ADDISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18180 JEFFERSON HWY
BATON ROUGE LA
70817-7423
US

IV. Provider business mailing address

4635 SOUTHWEST FWYTX SUITE 635
HOUSTON TX
77027
US

V. Phone/Fax

Practice location:
  • Phone: 225-291-8474
  • Fax:
Mailing address:
  • Phone: 713-850-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16611
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number16611
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: