Provider Demographics
NPI:1598387631
Name:ALLISON, TAMARA LEE (LICSW)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LEE
Last Name:ALLISON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 HAZEL DELL RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-9438
Mailing Address - Country:US
Mailing Address - Phone:360-270-4156
Mailing Address - Fax:
Practice Address - Street 1:2103 NE 129TH ST STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3270
Practice Address - Country:US
Practice Address - Phone:360-574-9303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607357591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical