Healthcare Provider Details

I. General information

NPI: 1053020529
Provider Name (Legal Business Name): DULCYANA LOUISE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8292 HIGHWAY 41
RINGGOLD GA
30736-2354
US

IV. Provider business mailing address

8292 HIGHWAY 41
RINGGOLD GA
30736-2354
US

V. Phone/Fax

Practice location:
  • Phone: 706-952-2800
  • Fax: 706-952-2802
Mailing address:
  • Phone: 706-952-2800
  • Fax: 706-952-2802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number01641
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: