Provider Demographics
NPI:1356898332
Name:EADS, ALLYSON
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:EADS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 E BROAD ST STE 301
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4037
Mailing Address - Country:US
Mailing Address - Phone:904-605-4986
Mailing Address - Fax:
Practice Address - Street 1:620 E BROAD ST STE 301
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4037
Practice Address - Country:US
Practice Address - Phone:904-605-4986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1901719-SUPV1041C0700X
OHS1201191104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker