Healthcare Provider Details

I. General information

NPI: 1912367699
Provider Name (Legal Business Name): ALLISON NICOLE LPC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON MANNIX LPC, LCADC

II. Dates (important events)

Enumeration Date: 02/24/2016
Last Update Date: 06/03/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MEMORIAL PARKWAY FAMILY GUIDANCE CENTER OF WARREN COUNTY
PHILLIPSBURG NJ
08865-1580
US

IV. Provider business mailing address

1220 STATE ROUTE 31
LEBANON NJ
08833-3268
US

V. Phone/Fax

Practice location:
  • Phone: 908-454-4470
  • Fax: 908-454-5317
Mailing address:
  • Phone: 845-821-1529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00297600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00592800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: