Healthcare Provider Details

I. General information

NPI: 1679469688
Provider Name (Legal Business Name): HENRY ALLEN SUPPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N MAIN ST APT 5F
HIGH POINT NC
27260-5018
US

IV. Provider business mailing address

650 N MAIN ST APT 5F
HIGH POINT NC
27260-5018
US

V. Phone/Fax

Practice location:
  • Phone: 678-984-8683
  • Fax:
Mailing address:
  • Phone: 678-984-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEDRA ALLEN
Title or Position: OWNER
Credential:
Phone: 678-984-8683