Provider Demographics
NPI:1275249146
Name:PUNTEL, ALISSA KENLYNN
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:KENLYNN
Last Name:PUNTEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 HILLTOP WEST CTR STE 319
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6132
Mailing Address - Country:US
Mailing Address - Phone:757-371-2700
Mailing Address - Fax:
Practice Address - Street 1:1604 HILLTOP WEST SHOPPING CTR STE 319
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6132
Practice Address - Country:US
Practice Address - Phone:757-371-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4055C1041C0700X
VA09040108481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical