1497764906 NPI number — B ALISON ALLSBROOK LCSW

Table of content: B ALISON ALLSBROOK LCSW (NPI 1497764906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497764906 NPI number — B ALISON ALLSBROOK LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLSBROOK
Provider First Name:
B
Provider Middle Name:
ALISON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497764906
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3716 MELROSE AVENUE, NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-362-0360
Provider Business Mailing Address Fax Number:
540-366-0429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3716 MELROSE AVENUE, NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-362-0360
Provider Business Practice Location Address Fax Number:
540-366-0429
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  0904001766 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 083900 . This is a "SENTARA/SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 228268000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3121131 . This is a "MAMSI/MDIPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541925036 . This is a "UHC/UBH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8938148 . This is a "VA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 008917183 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2164753 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7769008 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 232250 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 395229 . This is a "ANTHEM/ANTHEM HEALTHKEEP" identifier . This identifiers is of the category "OTHER".




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