Healthcare Provider Details

I. General information

NPI: 1811589328
Provider Name (Legal Business Name): ALLISON UDRIS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 BAYVIEW BOULEVARD SUITE 03A511
BALTIMORE MD
21224
US

IV. Provider business mailing address

251 BAYVIEW BLVD
BALTIMORE MD
21224-2816
US

V. Phone/Fax

Practice location:
  • Phone: 443-431-0909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC7957
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: