Provider Demographics
NPI:1639542244
Name:ALLISON, JASON (LAADC-CA, ICADC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ALLISON
Suffix:
Gender:M
Credentials:LAADC-CA, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7071 CONSOLIDATED WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2604
Mailing Address - Country:US
Mailing Address - Phone:619-452-1200
Mailing Address - Fax:
Practice Address - Street 1:7071 CONSOLIDATED WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2604
Practice Address - Country:US
Practice Address - Phone:619-452-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI0151214101YA0400X
CA710850101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)