Individual
ALYSSA NEWSOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LBA
Contact information
Practice address
51145 NICOLETTE DR, CHESTERFIELD, MI 48047-4585
(586) 228-9991
Mailing address
25845 TECLA AVE, WARREN, MI 48089-4113
(586) 484-8263
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401001104
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-20-41662
BEHAVIOR ANALYST CERTIFICATION BOARD
MI
Enumeration date
05/24/2020
Last updated
06/08/2020
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