Provider Demographics
NPI:1821782335
Name:ALLISON FENDER, LPC, LLC
Entity Type:Organization
Organization Name:ALLISON FENDER, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:MCMANUS
Authorized Official - Last Name:FENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:912-580-0989
Mailing Address - Street 1:1339 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-4261
Mailing Address - Country:US
Mailing Address - Phone:912-580-0989
Mailing Address - Fax:912-510-0754
Practice Address - Street 1:100 MARINERS DR STE D
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6667
Practice Address - Country:US
Practice Address - Phone:912-510-0669
Practice Address - Fax:912-510-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty