Provider Demographics
NPI:1730746678
Name:TABLES, ALLISON DENICE (LPC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:DENICE
Last Name:TABLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 HOPE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-2121
Mailing Address - Country:US
Mailing Address - Phone:203-539-1541
Mailing Address - Fax:
Practice Address - Street 1:1011 HOPE ST FL 2
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-2121
Practice Address - Country:US
Practice Address - Phone:203-539-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional