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General NPI Number Information
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NPI Number | 1265925796
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Entity Type | Organization
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Legal Business Name | THERAPY WITH ALYSE, LLC
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Dates
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Enumeration Date | 06/09/2018
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 1769 JAMESTOWN RD STE 207
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2307
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Country | US
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Telephone | 856-438-0694
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 4TH ST N STE 8058
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City | ST PETERSBURG
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State | FL
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Zip | 33702-4305
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Country | US
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Telephone | 856-438-0694
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | ALYSE HELENE ERGOOD MCKEAL
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Credential | LCSW
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Telephone | 856-438-0694
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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