Healthcare Provider Details

I. General information

NPI: 1376335307
Provider Name (Legal Business Name): ALYSSA COON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2025
Last Update Date: 05/17/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SIKES PL STE 325
CHARLOTTE NC
28277-8208
US

IV. Provider business mailing address

4699 PARKCREST CIR UNIT 207
INDIAN LAND SC
29707-9697
US

V. Phone/Fax

Practice location:
  • Phone: 704-247-7353
  • Fax:
Mailing address:
  • Phone: 703-474-9354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: