Healthcare Provider Details

I. General information

NPI: 1720266612
Provider Name (Legal Business Name): FRANCES ANN ALLEN-HENDERSON MA, LSW, LPC, ALPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1197 SAXON RD.
FAIRDALE WV
25839-0345
US

IV. Provider business mailing address

PO BOX 345
FAIRDALE WV
25839-0345
US

V. Phone/Fax

Practice location:
  • Phone: 304-934-5950
  • Fax: 304-934-5961
Mailing address:
  • Phone: 304-934-5950
  • Fax: 304-934-5961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number921
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: