Provider Demographics
NPI:1881427060
Name:MATTHIESSEN, ALYSSA MARIE (LPC-A)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MARIE
Last Name:MATTHIESSEN
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 RUDY DR
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-7063
Mailing Address - Country:US
Mailing Address - Phone:678-373-8925
Mailing Address - Fax:
Practice Address - Street 1:220 RUDY DR
Practice Address - Street 2:
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-7063
Practice Address - Country:US
Practice Address - Phone:678-373-8925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional