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General NPI Number Information
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NPI Number | 1215347596
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Entity Type | Individual
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Provider Name | ALISHA ANNMARIE DUSTY M.ED/ED.S, LCMHC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2014
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 4030 WAKE FOREST RD STE 349
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City | RALEIGH
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State | NC
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Zip | 27609-0010
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Country | US
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Telephone | 919-307-9222
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 156
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-0156
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Country | US
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Telephone | 919-307-9222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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