Provider Demographics
NPI:1679887095
Name:DELETETSKY, ALYSON MARIE (LPC)
Entity type:Individual
Prefix:MS
First Name:ALYSON
Middle Name:MARIE
Last Name:DELETETSKY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 ALAMANCE DR SE
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-7571
Mailing Address - Country:US
Mailing Address - Phone:207-590-9756
Mailing Address - Fax:910-363-4139
Practice Address - Street 1:655 GILBERT RD SE
Practice Address - Street 2:
Practice Address - City:BOLIVIA
Practice Address - State:NC
Practice Address - Zip Code:28422-8757
Practice Address - Country:US
Practice Address - Phone:207-590-9756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11933101Y00000X
MEXL3826101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor