Provider Demographics
NPI:1558322891
Name:TODD, ALLISON SHORT (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:SHORT
Last Name:TODD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:SHORT
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:6800 SAINT PETERS LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-8458
Mailing Address - Country:US
Mailing Address - Phone:704-536-0375
Mailing Address - Fax:704-531-9266
Practice Address - Street 1:419 S SHARON AMITY RD STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2856
Practice Address - Country:US
Practice Address - Phone:704-309-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0046731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002478Medicaid