Provider Demographics
NPI:1821299819
Name:MACK, ALLYSON JOHNSON (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:ALLYSON
Middle Name:JOHNSON
Last Name:MACK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SW 75TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-5779
Mailing Address - Country:US
Mailing Address - Phone:352-331-4621
Mailing Address - Fax:352-331-4681
Practice Address - Street 1:100 SW 75TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-5779
Practice Address - Country:US
Practice Address - Phone:352-331-4621
Practice Address - Fax:352-331-4681
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6886101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health