Provider Demographics
NPI:1356961791
Name:GAMBLE, ALISHA JANAE (LMHC)
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:JANAE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 RIVERPLACE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9032
Mailing Address - Country:US
Mailing Address - Phone:904-690-3900
Mailing Address - Fax:904-690-3930
Practice Address - Street 1:1301 RIVERPLACE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9032
Practice Address - Country:US
Practice Address - Phone:904-690-3900
Practice Address - Fax:904-690-3930
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH17981101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health