Individual
ALYSE FANDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
755 S MAIN ST, BAXLEY, GA 31513-0130
(912) 367-4614
(912) 367-9048
Mailing address
755 S MAIN ST, BAXLEY, GA 31513-0130
(912) 367-4614
(912) 367-9048
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC010854
GA
Other
Enumeration date
07/12/2019
Last updated
07/12/2019
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