Provider Demographics
NPI:1821322843
Name:DAUGHN, ALLISON STACY (PSYD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:STACY
Last Name:DAUGHN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 DR MARTIN LUTHER KING ST N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1472
Mailing Address - Country:US
Mailing Address - Phone:727-820-7747
Mailing Address - Fax:727-820-7797
Practice Address - Street 1:500 DR MARTIN LUTHER KING ST N
Practice Address - Street 2:SUITE 202
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1472
Practice Address - Country:US
Practice Address - Phone:727-820-7747
Practice Address - Fax:727-820-7797
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3721103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical