Provider Demographics
NPI:1386760312
Name:DENNIS, ALISA (PHD)
Entity type:Individual
Prefix:DR
First Name:ALISA
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 HILLHURST AVE # 114
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-2719
Mailing Address - Country:US
Mailing Address - Phone:818-929-6095
Mailing Address - Fax:
Practice Address - Street 1:5887 GLENRIDGE DR STE 230
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-9929
Practice Address - Country:US
Practice Address - Phone:818-693-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19671103TC0700X
CAPSY19671103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical