Provider Demographics
NPI:1376875633
Name:ALLISON, MICHELLE DAYNA (LMFT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAYNA
Last Name:ALLISON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 BROWNS RD
Mailing Address - Street 2:
Mailing Address - City:STORRS MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06268-2717
Mailing Address - Country:US
Mailing Address - Phone:860-933-5072
Mailing Address - Fax:860-456-3482
Practice Address - Street 1:638 BROWNS RD
Practice Address - Street 2:
Practice Address - City:STORRS MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06268-2717
Practice Address - Country:US
Practice Address - Phone:860-933-5072
Practice Address - Fax:860-456-3482
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-10
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist