Provider Demographics
NPI:1013898618
Name:HEATH, ALISSA MARIE (MS, RD, LD)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:HEATH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 TURNER POINTE RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-9091
Mailing Address - Country:US
Mailing Address - Phone:813-480-5554
Mailing Address - Fax:
Practice Address - Street 1:905 VERDAE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4097
Practice Address - Country:US
Practice Address - Phone:864-522-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3262133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty