Provider Demographics
NPI:1598473589
Name:MAXIE, ALYSSA DAWN (LMHP-R, MA)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DAWN
Last Name:MAXIE
Suffix:
Gender:F
Credentials:LMHP-R, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5324 MACEDONIA RD
Mailing Address - Street 2:
Mailing Address - City:EAST BEND
Mailing Address - State:NC
Mailing Address - Zip Code:27018-7252
Mailing Address - Country:US
Mailing Address - Phone:434-251-5628
Mailing Address - Fax:
Practice Address - Street 1:5324 MACEDONIA RD
Practice Address - Street 2:
Practice Address - City:EAST BEND
Practice Address - State:NC
Practice Address - Zip Code:27018-7252
Practice Address - Country:US
Practice Address - Phone:434-251-5628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health