Provider Demographics
NPI:1497822514
Name:ANGELIA K DUSSIA DBA ALETHEIA COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:ANGELIA K DUSSIA DBA ALETHEIA COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DUSSIA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, CDCA
Authorized Official - Phone:937-849-1257
Mailing Address - Street 1:2675 MEDWAY NEW CARLISLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45341-9744
Mailing Address - Country:US
Mailing Address - Phone:937-849-1257
Mailing Address - Fax:937-849-1336
Practice Address - Street 1:2675 MEDWAY NEW CARLISLE RD
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:OH
Practice Address - Zip Code:45341-9744
Practice Address - Country:US
Practice Address - Phone:937-849-1257
Practice Address - Fax:937-849-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0500552261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========027OtherCAREASOURCE