Healthcare Provider Details

I. General information

NPI: 1275249146
Provider Name (Legal Business Name): ALISSA KENLYNN PUNTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 E STATE ST
COLUMBUS OH
43215-4281
US

IV. Provider business mailing address

1604 HILLTOP WEST CTR STE 319
VIRGINIA BEACH VA
23451-6132
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 757-371-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4055C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010848
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2506237
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: