Basic Information
Provider Information
NPI: 1508241308
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLISON
FirstName: AMANDA
MiddleName: MCCAWLEY
NamePrefix:  
NameSuffix:  
Credential: LPCA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 58 WOODCREEK CIR
Address2:  
City: SWANNANOA
State: NC
PostalCode: 287789152
CountryCode: US
TelephoneNumber: 9542940985
FaxNumber: 8284392622
Practice Location
Address1: 207 QUEEN ST
Address2:  
City: MORGANTON
State: NC
PostalCode: 286553341
CountryCode: US
TelephoneNumber: 8284398191
FaxNumber: 8284392622
Other Information
ProviderEnumerationDate: 07/22/2015
LastUpdateDate: 07/22/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XA11432NCY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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