Healthcare Provider Details

I. General information

NPI: 1942195359
Provider Name (Legal Business Name): ALISSA MARIE HAWTHORNE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S UNIVERSITY BLVD STE 2H
MOBILE AL
36609-7860
US

IV. Provider business mailing address

820 S UNIVERSITY BLVD STE 2H
MOBILE AL
36609-7860
US

V. Phone/Fax

Practice location:
  • Phone: 251-340-2020
  • Fax:
Mailing address:
  • Phone: 251-340-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-371061
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: