Basic Information
| Provider Information | |||||||||
| NPI: | 1497764906 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLSBROOK | ||||||||
| FirstName: | B | ||||||||
| MiddleName: | ALISON | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3716 MELROSE AVENUE, NW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403620360 | ||||||||
| FaxNumber: | 5403660429 | ||||||||
| Practice Location | |||||||||
| Address1: | 3716 MELROSE AVENUE, NW | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403620360 | ||||||||
| FaxNumber: | 5403660429 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 10/15/2019 | ||||||||
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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 | 1041C0700X | 0904001766 | VA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 083900 | 01 | SENTARA/SOUTHERN HEALTH | OTHER | 228268000 | 01 | MAGELLAN | OTHER | 3121131 | 01 | MAMSI/MDIPA | OTHER | 541925036 | 01 | UHC/UBH | OTHER | 8938148 | 01 | VA | VA PREMIER | OTHER | 008917183 | 05 | VA | MEDICAID | 2164753 | 01 | CIGNA | OTHER | 7769008 | 01 | AETNA | OTHER | 232250 | 01 | VALUE OPTIONS | OTHER | 395229 | 01 | ANTHEM/ANTHEM HEALTHKEEP | OTHER |