MEDICARE: MS. ALYSON MARIE DELETETSKY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	11933	NC

General Provider Information

NPI Number	:	1679887095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALYSON MARIE DELETETSKY LPC

Provider Business Mailing Address
First Line	:	4937 ALAMANCE DR SE
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-7571
Country	:	US
Telephone Number	:	207-590-9756
Fax Number	:	910-363-4139

Provider Business Practice Location Address
First Line	:	655 GILBERT RD SE
Second Line	:
City	:	BOLIVIA
State	:	NC
Zip	:	28422-8757
Country	:	US
Telephone Number	:	207-590-9756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	05/24/2016

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