Provider Demographics
NPI:1154774479
Name:FAJAYAN, ALYSSA CATHERINE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:CATHERINE
Last Name:FAJAYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95947-0554
Mailing Address - Country:US
Mailing Address - Phone:530-284-7007
Mailing Address - Fax:530-284-7111
Practice Address - Street 1:4600 KIETZKE LN
Practice Address - Street 2:SUITE O-260
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5033
Practice Address - Country:US
Practice Address - Phone:775-825-9995
Practice Address - Fax:775-825-9877
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker