Provider Demographics
NPI:1275428237
Name:VALDEZ, ALYSSA KITANA
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KITANA
Last Name:VALDEZ
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 1:224 THORNCREST DR
Mailing Address - Street 2:
Mailing Address - City:PAULINE
Mailing Address - State:SC
Mailing Address - Zip Code:29374-1626
Mailing Address - Country:US
Mailing Address - Phone:864-590-0458
Mailing Address - Fax:
Practice Address - Street 1:224 THORNCREST DR
Practice Address - Street 2:
Practice Address - City:PAULINE
Practice Address - State:SC
Practice Address - Zip Code:29374-1626
Practice Address - Country:US
Practice Address - Phone:864-590-0458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0-25-16185106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst