Provider Demographics
NPI:1437939717
Name:AVERY, ALISSA CHARI (CAPTPSUDRC15889)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:CHARI
Last Name:AVERY
Suffix:
Gender:F
Credentials:CAPTPSUDRC15889
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 6TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3834
Mailing Address - Country:US
Mailing Address - Phone:831-265-7317
Mailing Address - Fax:831-265-7462
Practice Address - Street 1:335 6TH ST
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3834
Practice Address - Country:US
Practice Address - Phone:831-265-7317
Practice Address - Fax:831-265-7462
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15889101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)