Provider Demographics
NPI:1578012258
Name:ALDERMAN, CLARISSA YOLANDA (MS, EDS, ICAADC)
Entity type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:YOLANDA
Last Name:ALDERMAN
Suffix:
Gender:F
Credentials:MS, EDS, ICAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 N FORREST RUN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601
Mailing Address - Country:US
Mailing Address - Phone:229-249-9513
Mailing Address - Fax:229-249-9513
Practice Address - Street 1:4107 N FORREST RUN CIRCLE
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601
Practice Address - Country:US
Practice Address - Phone:229-249-9513
Practice Address - Fax:229-249-9513
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
GA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional