Provider Demographics
NPI:1609388057
Name:WISE, ALLYSON (LCMHC)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:WISE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 RUBY RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-8081
Mailing Address - Country:US
Mailing Address - Phone:802-793-7955
Mailing Address - Fax:
Practice Address - Street 1:200 PARK ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8659
Practice Address - Country:US
Practice Address - Phone:802-793-7955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0087759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health