Provider Demographics
NPI:1578295796
Name:BARTH, ALYSSA (APC)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:BARTH
Suffix:
Gender:F
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-1903
Mailing Address - Country:US
Mailing Address - Phone:912-282-0992
Mailing Address - Fax:912-285-8817
Practice Address - Street 1:419 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-1903
Practice Address - Country:US
Practice Address - Phone:912-282-0992
Practice Address - Fax:912-285-8817
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional