Healthcare Provider Details

I. General information

NPI: 1770605818
Provider Name (Legal Business Name): VIRGINIA VAN ALLEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUNWOODY PARK SUITE 140
ATLANTA GA
30338-7404
US

IV. Provider business mailing address

685 ARGONNE AVE NE UNIT 2
ATLANTA GA
30308-2036
US

V. Phone/Fax

Practice location:
  • Phone: 678-665-5153
  • Fax: 770-390-0877
Mailing address:
  • Phone: 678-665-5153
  • Fax: 770-390-0877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW002630
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: