Provider Demographics
NPI:1013560937
Name:KRYSIAK, ALYSSA (LPCA, ATR)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:KRYSIAK
Suffix:
Gender:F
Credentials:LPCA, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GRAMPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-7201
Mailing Address - Country:US
Mailing Address - Phone:585-943-2628
Mailing Address - Fax:
Practice Address - Street 1:185 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-2354
Practice Address - Country:US
Practice Address - Phone:910-585-9074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional