Provider Demographics
NPI:1386970630
Name:BLISS, ALISHA MARIE (CSAC, LADC)
Entity type:Individual
Prefix:MISS
First Name:ALISHA
Middle Name:MARIE
Last Name:BLISS
Suffix:
Gender:F
Credentials:CSAC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 TOWER AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2532
Mailing Address - Country:US
Mailing Address - Phone:715-392-9300
Mailing Address - Fax:715-392-8041
Practice Address - Street 1:1507 TOWER AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2532
Practice Address - Country:US
Practice Address - Phone:715-392-9300
Practice Address - Fax:715-392-8041
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13428-0130101YA0400X
MN101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)