Provider Demographics
NPI:1417830696
Name:BROUGHTON, ALLISON OLIVER (MA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:OLIVER
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:AUDREY
Other - Last Name:OLIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:940 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4650
Mailing Address - Country:US
Mailing Address - Phone:404-277-7904
Mailing Address - Fax:
Practice Address - Street 1:940 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4650
Practice Address - Country:US
Practice Address - Phone:404-277-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty