Provider Demographics
NPI:1477311249
Name:SPECKHARD, ALLISON (MS)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:SPECKHARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 ENTERPRISE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-1992
Mailing Address - Country:US
Mailing Address - Phone:336-808-5488
Mailing Address - Fax:336-500-8746
Practice Address - Street 1:2125 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-1992
Practice Address - Country:US
Practice Address - Phone:336-808-5488
Practice Address - Fax:336-500-8746
Is Sole Proprietor?:No
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health