Basic Information
| Provider Information | |||||||||
| NPI: | 1972953040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRISLIP | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A., BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 207D COLEGATE DR | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457502363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403760930 | ||||||||
| FaxNumber: | 7403760933 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 MACKENAN DR | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275117903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193712848 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2016 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 103K00000X | 1-15-21308 | NC | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.