Healthcare Provider Details

I. General information

NPI: 1316367030
Provider Name (Legal Business Name): ALISSA JEANNE WALSH LPC, CAADC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W 7TH ST STE 100
ERIE PA
16502-1333
US

IV. Provider business mailing address

5020 SPRINGFIELD AVE
PHILADELPHIA PA
19143-4233
US

V. Phone/Fax

Practice location:
  • Phone: 267-223-7044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10382
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number27793077
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011417
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number18-050
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: