Provider Demographics
NPI:1770814139
Name:SHANK, ALYSSA KAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:KAY
Last Name:SHANK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 E MOLER AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-4729
Mailing Address - Country:US
Mailing Address - Phone:540-742-3723
Mailing Address - Fax:540-300-1193
Practice Address - Street 1:829 E MOLER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-4729
Practice Address - Country:US
Practice Address - Phone:540-513-4622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004766101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor