Provider Demographics
NPI:1588318885
Name:DEGRACE, ALYSSA (LGPC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:DEGRACE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 MING AVE # 265
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4689
Mailing Address - Country:US
Mailing Address - Phone:301-987-7284
Mailing Address - Fax:
Practice Address - Street 1:7945 MACARTHUR BLVD STE 214
Practice Address - Street 2:
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1634
Practice Address - Country:US
Practice Address - Phone:301-987-7284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health