Healthcare Provider Details

I. General information

NPI: 1083863450
Provider Name (Legal Business Name): AYANNA AFRIKA ALLEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. AYANNA AFRIKA SOLGATE

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HANCOCK STREET
SAGINAW MI
48602-4224
US

IV. Provider business mailing address

500 HANCOCK STREET
SAGINAW MI
48602-4224
US

V. Phone/Fax

Practice location:
  • Phone: 989-797-3400
  • Fax: 989-799-0206
Mailing address:
  • Phone: 989-797-3400
  • Fax: 989-799-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801085522
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801085522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: