Individual
ALISA ANN DAMHOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C-11264
NM
104100000X
Social Worker
M-10135
NM
1041C0700X
Clinical Social Worker
Primary
34010704A
IN
Other
Enumeration date
12/16/2018
Last updated
06/27/2026
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