Provider Demographics
NPI:1992163521
Name:WOODS, ALISA GENEVIEVE (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:ALISA
Middle Name:GENEVIEVE
Last Name:WOODS
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1816
Mailing Address - Country:US
Mailing Address - Phone:315-244-7643
Mailing Address - Fax:
Practice Address - Street 1:25 MARKET ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2173
Practice Address - Country:US
Practice Address - Phone:315-244-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health