Provider Demographics
NPI:1396100608
Name:DARNELL, ALISSA LEE (LPC)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:LEE
Last Name:DARNELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:LEE
Other - Last Name:DARNELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0011
Mailing Address - Country:US
Mailing Address - Phone:770-365-1477
Mailing Address - Fax:
Practice Address - Street 1:1020 BARBER CREEK DR STE 213
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677
Practice Address - Country:US
Practice Address - Phone:770-365-1477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC007297101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional