Provider Demographics
NPI:1639430911
Name:WELLIVER, ALLISON L (LHMC, CAP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:L
Last Name:WELLIVER
Suffix:
Gender:F
Credentials:LHMC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 420 BOX 1843
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09063-0019
Mailing Address - Country:US
Mailing Address - Phone:491511-947-8526
Mailing Address - Fax:
Practice Address - Street 1:CMR 420 BOX 1843
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09063-0019
Practice Address - Country:US
Practice Address - Phone:491511-947-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9683101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health