Provider Demographics
NPI:1023635174
Name:KNIGHT, ALISSA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:
Last Name:KNIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:MICHELLE
Other - Last Name:MENENDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1160 CRESCENT PKWY
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-3713
Mailing Address - Country:US
Mailing Address - Phone:386-848-1786
Mailing Address - Fax:
Practice Address - Street 1:1160 CRESCENT PKWY
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-3713
Practice Address - Country:US
Practice Address - Phone:386-848-1786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
148751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical