Provider Demographics
NPI:1902681364
Name:GREENLAW, ALISHA K (MS)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:K
Last Name:GREENLAW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 LEWIS TURNER BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1352
Mailing Address - Country:US
Mailing Address - Phone:850-616-7131
Mailing Address - Fax:
Practice Address - Street 1:2018 LEWIS TURNER BLVD STE C
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1352
Practice Address - Country:US
Practice Address - Phone:850-616-7131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24240101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health