Healthcare Provider Details

I. General information

NPI: 1780973339
Provider Name (Legal Business Name): ALYSSA J. CARLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 HWY. 421 S.
BUIES CREEK NC
27506-0457
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR. SUITE 100
CONCORD NC
28025-1894
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-5727
  • Fax:
Mailing address:
  • Phone: 704-939-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA8397
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: