Healthcare Provider Details

I. General information

NPI: 1346179363
Provider Name (Legal Business Name): ALLISON WAYNE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 EMMET ST S
CHARLOTTESVILLE VA
22903-2424
US

IV. Provider business mailing address

417 EMMET ST S
CHARLOTTESVILLE VA
22903-2424
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-7034
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009171
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: