Provider Demographics
NPI:1063028868
Name:WIVIOTT, ALLYANA RACHEL (MHC-LP)
Entity Type:Individual
Prefix:
First Name:ALLYANA
Middle Name:RACHEL
Last Name:WIVIOTT
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 5TH AVE APT 4L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2576
Mailing Address - Country:US
Mailing Address - Phone:415-378-5334
Mailing Address - Fax:
Practice Address - Street 1:493 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-5117
Practice Address - Country:US
Practice Address - Phone:929-399-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106815-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health