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General NPI Number Information
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NPI Number | 1669787115
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Entity Type | Individual
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Provider Name | GINA MARIE ALLISON LPC
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Gender | Female
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 390 1ST ST SW SUITE 2B
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City | BANDON
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State | OR
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Zip | 97411-4500
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Country | US
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Telephone | 541-329-0555
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1387
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City | BANDON
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State | OR
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Zip | 97411-1387
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Country | US
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Telephone | 541-329-0555
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C2507
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 636
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License Number State | AK
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