Healthcare Provider Details

I. General information

NPI: 1659884781
Provider Name (Legal Business Name): ALISHA TEMPLES MPH, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2017
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MADISON ST STE 320B
ALEXANDRIA VA
22314-1764
US

IV. Provider business mailing address

349 S PICKETT ST
ALEXANDRIA VA
22304-4747
US

V. Phone/Fax

Practice location:
  • Phone: 872-529-6420
  • Fax: 703-215-3078
Mailing address:
  • Phone: 872-529-6420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: