Healthcare Provider Details

I. General information

NPI: 1396652327
Provider Name (Legal Business Name): AARON ALLEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 ISLAND PROFESSIONAL PARK
ST SIMONS IS GA
31522-2880
US

IV. Provider business mailing address

77 MAXWELL AVE
ST SIMONS IS GA
31522-1803
US

V. Phone/Fax

Practice location:
  • Phone: 706-809-4124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT002425
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: