Provider Demographics
NPI:1386461044
Name:LARGENT, ALLISON LEIGH (EDS)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEIGH
Last Name:LARGENT
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:LEIGH
Other - Last Name:ULM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1492 COLES DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4706
Mailing Address - Country:US
Mailing Address - Phone:484-888-2752
Mailing Address - Fax:
Practice Address - Street 1:1492 COLES DR
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4706
Practice Address - Country:US
Practice Address - Phone:484-888-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool