Healthcare Provider Details

I. General information

NPI: 1932323482
Provider Name (Legal Business Name): CONSTANCE FRYE ALSUP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 S A ST
RICHMOND IN
47374-6049
US

IV. Provider business mailing address

5379 W PATRICIA DR
CONNERSVILLE IN
47331-9751
US

V. Phone/Fax

Practice location:
  • Phone: 765-962-8843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: