Provider Demographics
NPI:1073846705
Name:THIR, ALISON WITMER (PSYD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:WITMER
Last Name:THIR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:
Other - Last Name:WITMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3120 MAYBERRY AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20639-3910
Mailing Address - Country:US
Mailing Address - Phone:703-568-0900
Mailing Address - Fax:
Practice Address - Street 1:134 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-6150
Practice Address - Country:US
Practice Address - Phone:301-744-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MD04728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561802Medicaid