Provider Demographics
NPI:1386840031
Name:BLACKWELL, ALISHA LACHELLE (LADC)
Entity type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:LACHELLE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC/LCDC
Mailing Address - Street 1:9313 NW 76TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9790
Mailing Address - Country:US
Mailing Address - Phone:405-410-7452
Mailing Address - Fax:
Practice Address - Street 1:4436 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2212
Practice Address - Country:US
Practice Address - Phone:405-858-2700
Practice Address - Fax:405-858-2880
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK1447101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor