Healthcare Provider Details

I. General information

NPI: 1285884700
Provider Name (Legal Business Name): ALISSA WILLIAMS I PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALISSA LORD PSYD

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date: 06/15/2020
Reactivation Date: 05/05/2022

III. Provider practice location address

87 STILES RD STE 106
SALEM NH
03079-2899
US

IV. Provider business mailing address

2300 HAGGERTY RD SUITE 2160
WEST BLOOMFIELD MI
48323-2184
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-7700
  • Fax:
Mailing address:
  • Phone: 248-539-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: