Provider Demographics
NPI:1407826142
Name:FORD, ALLISON BRONWYN (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:BRONWYN
Last Name:FORD
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CLOISTER CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2207
Mailing Address - Country:US
Mailing Address - Phone:919-636-5210
Mailing Address - Fax:919-636-5220
Practice Address - Street 1:101 CLOISTER CT
Practice Address - Street 2:SUITE D
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2207
Practice Address - Country:US
Practice Address - Phone:919-636-5210
Practice Address - Fax:919-636-5220
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3292LPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103370Medicaid