Healthcare Provider Details

I. General information

NPI: 1174899371
Provider Name (Legal Business Name): VINCENT CASEY ALLEN JR. LP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2012
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NORTHSIDE DR NW STE A7
ATLANTA GA
30318-2695
US

IV. Provider business mailing address

1700 NORTHSIDE DR SUITE A7, UNIT #5110
ATLANTA GA
30318
US

V. Phone/Fax

Practice location:
  • Phone: 404-999-7605
  • Fax:
Mailing address:
  • Phone: 404-999-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004182
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: