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General NPI Number Information
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NPI Number | 1427675628
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Entity Type | Individual
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Provider Name | ALLISON MACDONALD LISAC
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Gender | Female
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Dates
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Enumeration Date | 07/03/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 41810 N VENTURE DR UNIT E160
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City | ANTHEM
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State | AZ
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Zip | 85086-3177
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Country | US
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Telephone | 26-935-9222
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Fax |
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Provider Business Mailing Address
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Address Line | 3655 W ANTHEM WAY A-109 PMB 388
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City | ANTHEM
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State | AZ
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Zip | 85086-2776
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Country | US
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Telephone | 602-935-9222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 15183
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License Number State | AZ
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