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General NPI Number Information
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NPI Number | 1538464474
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Entity Type | Individual
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Provider Name | MARY ALLISON MA, LPC/MHSP
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Gender | Female
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 204 MEMORIAL DR
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City | BRISTOL
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State | TN
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Zip | 37620-1704
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Country | US
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Telephone | 423-383-4149
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Fax | 423-573-1716
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Provider Business Mailing Address
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Address Line | 209 RICHMOND HEIGHTS RD
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City | BRISTOL
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State | TN
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Zip | 37620-6611
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Country | US
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Telephone | 423-383-4149
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Fax | 423-573-1716
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3040
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License Number State | TN
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