Basic Information
| Provider Information | |||||||||
| NPI: | 1326460650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOVER-THOMPSON | ||||||||
| FirstName: | ALYSIA | ||||||||
| MiddleName: | ANN | ||||||||
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| OtherLastName: | HOOVER | ||||||||
| OtherFirstName: | ALYSIA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherCredential: | PSY.D | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 185 REDWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | PENNINGTON GAP | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242772599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765465310 | ||||||||
| FaxNumber: | 2765465469 | ||||||||
| Practice Location | |||||||||
| Address1: | 162 MEDICAL CENTER BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | HAYSI | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2768655121 | ||||||||
| FaxNumber: | 2768655652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2014 | ||||||||
| LastUpdateDate: | 01/06/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 0810004920 | VA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.