Healthcare Provider Details

I. General information

NPI: 1316349772
Provider Name (Legal Business Name): THE T ALLEN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 PINCKNEY ST
WHITEVILLE NC
28472-2220
US

IV. Provider business mailing address

227 WENDY PL
BENSON NC
27504-7997
US

V. Phone/Fax

Practice location:
  • Phone: 919-820-2554
  • Fax: 855-640-5434
Mailing address:
  • Phone: 919-820-2554
  • Fax: 855-640-5434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number9801445
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number9801445
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number253205
License Number StateNC

VIII. Authorized Official

Name: TERESA ALLEN
Title or Position: OWNER
Credential:
Phone: 919-820-2554