Healthcare Provider Details

I. General information

NPI: 1578012258
Provider Name (Legal Business Name): CLARISSA YOLANDA ALDERMAN MS, EDS, ICAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4107 N FORREST RUN CIRCLE
VALDOSTA GA
31601
US

IV. Provider business mailing address

4107 FORREST RUN CIR
VALDOSTA GA
31605-6535
US

V. Phone/Fax

Practice location:
  • Phone: 229-249-9513
  • Fax: 229-249-9513
Mailing address:
  • Phone: 229-249-9513
  • Fax: 229-249-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC009560
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009560
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: