Provider Demographics
NPI:1689787392
Name:REVENSON, ALLISON P (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:P
Last Name:REVENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 HICKORY PARK DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059
Mailing Address - Country:US
Mailing Address - Phone:804-237-8030
Mailing Address - Fax:804-730-8028
Practice Address - Street 1:5213 HICKORY PARK DRIVE
Practice Address - Street 2:STE A
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059
Practice Address - Country:US
Practice Address - Phone:804-237-8030
Practice Address - Fax:804-237-8028
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040016511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA031547OtherVALUE OPTIONS
VA147178OtherANTHEM BCBS
VA2080448OtherCIGNA
VA031547OtherVALUE OPTIONS