Healthcare Provider Details

I. General information

NPI: 1902502115
Provider Name (Legal Business Name): ALYSSA HEDLUND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WINCHESTER CT
MAULDIN SC
29662-2627
US

IV. Provider business mailing address

209 7TH ST FL 3
AUGUSTA GA
30901-1486
US

V. Phone/Fax

Practice location:
  • Phone: 706-842-5330
  • Fax:
Mailing address:
  • Phone: 706-739-7706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2834102
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: