Provider Demographics
NPI:1114081445
Name:HORNBACK, ALLISON RENEE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:RENEE
Last Name:HORNBACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2524
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-2524
Mailing Address - Country:US
Mailing Address - Phone:407-330-0418
Mailing Address - Fax:407-321-0059
Practice Address - Street 1:200 N PARK AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1242
Practice Address - Country:US
Practice Address - Phone:407-330-0418
Practice Address - Fax:407-321-0059
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 7112104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker