Provider Demographics
NPI:1881124170
Name:BAIN, ALYSSA DAWN (LCSW)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DAWN
Last Name:BAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:CULLOWHEE
Mailing Address - State:NC
Mailing Address - Zip Code:28723-5128
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 FOX HOLLOW RD
Practice Address - Street 2:
Practice Address - City:CULLOWHEE
Practice Address - State:NC
Practice Address - Zip Code:28723-5128
Practice Address - Country:US
Practice Address - Phone:828-283-0035
Practice Address - Fax:828-544-1201
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-19
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0129611041C0700X
NCP0114261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical