Provider Demographics
NPI:1932794286
Name:WESTON, ALIYATTA PAULLONE (MS IN PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:ALIYATTA
Middle Name:PAULLONE
Last Name:WESTON
Suffix:
Gender:F
Credentials:MS IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 SE LEMON WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-2273
Mailing Address - Country:US
Mailing Address - Phone:386-361-1455
Mailing Address - Fax:
Practice Address - Street 1:540 SW FEDORA WAY
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025
Practice Address - Country:US
Practice Address - Phone:386-361-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19017101YM0800X
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty