Healthcare Provider Details

I. General information

NPI: 1215553888
Provider Name (Legal Business Name): ALYSSA LIANE ROVDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5248 OLDE TOWNE RD STE 10
WILLIAMSBURG VA
23188-1986
US

IV. Provider business mailing address

3209 CARRIAGE HOUSE WAY
WILLIAMSBURG VA
23188-2765
US

V. Phone/Fax

Practice location:
  • Phone: 757-603-4603
  • Fax:
Mailing address:
  • Phone: 703-509-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: