Provider Demographics
NPI:1194386243
Name:ROE, ALLISON (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:ROE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:DOMINICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-0567
Mailing Address - Fax:
Practice Address - Street 1:810 TYVOLA RD STE 126
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3536
Practice Address - Country:US
Practice Address - Phone:704-566-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0142441041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical