Basic Information
| Provider Information | |||||||||
| NPI: | 1306482674 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALFORD | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 504 PEA RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286559842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6013414743 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8007 N POINT BLVD STE 209 | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271063268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667001606 | ||||||||
| FaxNumber: | 8663385921 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2019 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | A15189 | NC | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | A15189 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.