Healthcare Provider Details

I. General information

NPI: 1992495923
Provider Name (Legal Business Name): ALLYSON TARBOX LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E DIAMOND AVE STE H
GAITHERSBURG MD
20877-5328
US

IV. Provider business mailing address

245 WALGROVE RD
REISTERSTOWN MD
21136-2315
US

V. Phone/Fax

Practice location:
  • Phone: 443-591-7681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26785
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: