Healthcare Provider Details

I. General information

NPI: 1730029984
Provider Name (Legal Business Name): ALLYSON PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BRIARWOOD DR
SHADY SPRING WV
25918-8437
US

IV. Provider business mailing address

206 BRIARWOOD DR
SHADY SPRING WV
25918-8437
US

V. Phone/Fax

Practice location:
  • Phone: 304-575-3906
  • Fax:
Mailing address:
  • Phone: 304-575-3906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: