Provider Demographics
NPI:1407290117
Name:BASHAM, ALLISON ZITO (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:ZITO
Last Name:BASHAM
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SUN VALLEY DR
Mailing Address - Street 2:SUITE P-4
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5612
Mailing Address - Country:US
Mailing Address - Phone:678-381-1687
Mailing Address - Fax:678-381-8020
Practice Address - Street 1:555 SUN VALLEY DR
Practice Address - Street 2:SUITE P-4
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5612
Practice Address - Country:US
Practice Address - Phone:678-381-1687
Practice Address - Fax:678-381-8020
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-24
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006374101YA0400X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health