Individual
DR. ALLISON MARIE DEATHERAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
204 W HILL BLVD, CHARLESTON AFB, SC 29404-4704
(843) 963-6852
Mailing address
PO BOX 21467, COLUMBUS, OH 43221-0467
(614) 380-9371
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
7351
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2614899
—
OH
Enumeration date
05/09/2007
Last updated
11/20/2020
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