Healthcare Provider Details

I. General information

NPI: 1215284906
Provider Name (Legal Business Name): KATIE TART ALLEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 RALEIGH ST
HOLLY SPRINGS NC
27540-9043
US

IV. Provider business mailing address

128 RALEIGH ST
HOLLY SPRINGS NC
27540-9043
US

V. Phone/Fax

Practice location:
  • Phone: 404-480-0332
  • Fax: 919-551-7569
Mailing address:
  • Phone: 404-480-0332
  • Fax: 919-551-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY003583
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4833
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: