Provider Demographics
NPI:1104000652
Name:POLOMSKY, ALLISON (MA, LCMFT, LMFT)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:POLOMSKY
Suffix:
Gender:F
Credentials:MA, LCMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18747 VERNON COURT
Mailing Address - Street 2:
Mailing Address - City:DRAYDEN
Mailing Address - State:MD
Mailing Address - Zip Code:20630
Mailing Address - Country:US
Mailing Address - Phone:402-682-2299
Mailing Address - Fax:
Practice Address - Street 1:22776 THREE NOTCH RD STE 211
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-3368
Practice Address - Country:US
Practice Address - Phone:301-304-8995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM630106H00000X
NE157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist