Healthcare Provider Details

I. General information

NPI: 1053277541
Provider Name (Legal Business Name): ALYSSA WHITTAKER LPCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 BETHEL ST
CLOVER SC
29710-1154
US

IV. Provider business mailing address

508 BETHEL ST
CLOVER SC
29710-1154
US

V. Phone/Fax

Practice location:
  • Phone: 803-675-8227
  • Fax:
Mailing address:
  • Phone: 803-675-8227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCOU.10725PCI
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: