Provider Demographics
NPI:1295961738
Name:DORIUS, ALYSSA CHRISTIE (BS)
Entity type:Individual
Prefix:MS
First Name:ALYSSA
Middle Name:CHRISTIE
Last Name:DORIUS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 UNION AVENUE EXT STE 400
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-4436
Mailing Address - Country:US
Mailing Address - Phone:901-320-6100
Mailing Address - Fax:901-320-6101
Practice Address - Street 1:2714 UNION AVENUE EXT STE 400
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-4436
Practice Address - Country:US
Practice Address - Phone:901-320-6100
Practice Address - Fax:901-320-6101
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO$$$$$$$$$OtherSOCIAL SECURITY NUMBER