Provider Demographics
NPI:1427675628
Name:MACDONALD, ALLISON (LISAC)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 W ANTHEM WAY
Mailing Address - Street 2:A-109 PMB 388
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2776
Mailing Address - Country:US
Mailing Address - Phone:602-935-9222
Mailing Address - Fax:
Practice Address - Street 1:41810 N VENTURE DR UNIT E160
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3177
Practice Address - Country:US
Practice Address - Phone:026-935-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-03
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)