Provider Demographics
NPI:1295270098
Name:LABIAK, ALYSSA (BA)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:LABIAK
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MISS
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:MCCONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 INDIGO CT APT C
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-2468
Mailing Address - Country:US
Mailing Address - Phone:757-777-5499
Mailing Address - Fax:
Practice Address - Street 1:15891 COUNTY ROAD 108
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:FL
Practice Address - Zip Code:32046-6733
Practice Address - Country:US
Practice Address - Phone:904-675-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator