Provider Demographics
NPI:1790944635
Name:ALLISON, VIRGINIA LICKEL (MED, NCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:LICKEL
Last Name:ALLISON
Suffix:
Gender:F
Credentials:MED, NCC, LPC
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:GENE
Other - Last Name:LICKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, NCC, LPC
Mailing Address - Street 1:1902 N ELM ST APT B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2148
Mailing Address - Country:US
Mailing Address - Phone:336-272-3488
Mailing Address - Fax:
Practice Address - Street 1:1902 N ELM ST APT B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2148
Practice Address - Country:US
Practice Address - Phone:336-272-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC784101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor