Provider Demographics
NPI:1619534898
Name:LASTRES, ALISSA M (NCC)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:M
Last Name:LASTRES
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:M
Other - Last Name:VREELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:371 HILLVIEW DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:524 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3517
Practice Address - Country:US
Practice Address - Phone:610-600-9714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty