Provider Demographics
NPI:1205582046
Name:ELLIOTT, ALLYSON MEREDITH (BCABA)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MEREDITH
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3126 W CARY ST # 116
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-3504
Mailing Address - Country:US
Mailing Address - Phone:252-677-5100
Mailing Address - Fax:252-677-5110
Practice Address - Street 1:35 SOUTHGATE CT STE 101
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-9670
Practice Address - Country:US
Practice Address - Phone:540-440-7027
Practice Address - Fax:540-579-2458
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
NC02113211106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0-21-13211Medicaid