Provider Demographics
NPI:1053752469
Name:ALLISON, KEVIN VINCE JR
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:VINCE
Last Name:ALLISON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 SAFFIR CT
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-8949
Mailing Address - Country:US
Mailing Address - Phone:704-777-1407
Mailing Address - Fax:
Practice Address - Street 1:10106 SAFFIR CT
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-8949
Practice Address - Country:US
Practice Address - Phone:704-777-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities