Provider Demographics
NPI:1790065704
Name:PREVOST, ALISON LEIGH (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:LEIGH
Last Name:PREVOST
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 NE 45TH ST STE 315
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4656
Mailing Address - Country:US
Mailing Address - Phone:206-785-1593
Mailing Address - Fax:
Practice Address - Street 1:1107 NE 45TH ST STE 315
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4656
Practice Address - Country:US
Practice Address - Phone:206-785-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW605018881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical