MEDICARE: ALYSSA DANEL MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701010018	VA

General Provider Information

NPI Number	:	1437758075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA DANEL MEDINA

Provider Business Mailing Address
First Line	:	4831 COLUMBUS ST UNIT 61202
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23466-1217
Country	:	US
Telephone Number	:	757-797-4140
Fax Number	:

Provider Business Practice Location Address
First Line	:	4831 COLUMBUS ST UNIT 61202
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23466-1217
Country	:	US
Telephone Number	:	757-797-4140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2020
Last Update Date	:	09/04/2024

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Directions to “ ALYSSA DANEL MEDINA ” Practice Location

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