Provider Demographics
NPI:1043909898
Name:PRATT, ALISHA LYNN (LSW)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:LYNN
Last Name:PRATT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 BRADENTON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3551
Mailing Address - Country:US
Mailing Address - Phone:614-580-6917
Mailing Address - Fax:
Practice Address - Street 1:4995 BRADENTON AVE STE 130
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3551
Practice Address - Country:US
Practice Address - Phone:614-580-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.178769101YA0400X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)