Individual
ALLISON SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
755 WAVERLY AVE, SUITE 312, HOLTSVILLE, NY 11742-1190
(631) 965-1502
Mailing address
18 FOREST LANE, CORAM, NY 11727-3139
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
000709-1
NY
Other
Enumeration date
08/13/2009
Last updated
01/12/2015
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