Provider Demographics
NPI:1689663122
Name:WALSH, ALLISON LENORE (BA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LENORE
Last Name:WALSH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 US HIGHWAY 1 S
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3708
Mailing Address - Country:US
Mailing Address - Phone:904-825-5048
Mailing Address - Fax:904-825-6824
Practice Address - Street 1:1955 US HIGHWAY 1 S
Practice Address - Street 2:SUITE C-2
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3708
Practice Address - Country:US
Practice Address - Phone:904-825-5048
Practice Address - Fax:904-825-6824
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health