Healthcare Provider Details

I. General information

NPI: 1316656523
Provider Name (Legal Business Name): ALYSSA EALY MIDDLETON MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 MCGINNIS FERRY RD
ALPHARETTA GA
30005-3948
US

IV. Provider business mailing address

4080 MCGINNIS FERRY RD STE 1304
ALPHARETTA GA
30005-3951
US

V. Phone/Fax

Practice location:
  • Phone: 678-306-6249
  • Fax:
Mailing address:
  • Phone: 678-446-9636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015555
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: