Healthcare Provider Details

I. General information

NPI: 1770216038
Provider Name (Legal Business Name): ALYCIA LASSITER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S CHURCH ST STE A
ASHEBORO NC
27203-5678
US

IV. Provider business mailing address

525 S CHURCH ST STE A
ASHEBORO NC
27203-5678
US

V. Phone/Fax

Practice location:
  • Phone: 336-628-0109
  • Fax:
Mailing address:
  • Phone: 336-628-0109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA20246
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: