Healthcare Provider Details

I. General information

NPI: 1255058905
Provider Name (Legal Business Name): ALLISON LONGWORTH MS, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 LIBBIE AVE FL 1
RICHMOND VA
23226-1829
US

IV. Provider business mailing address

1601 BRAMWELL RD
RICHMOND VA
23225-7803
US

V. Phone/Fax

Practice location:
  • Phone: 804-665-4681
  • Fax:
Mailing address:
  • Phone: 540-815-2034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12743
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: