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General NPI Number Information
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NPI Number | 1033719075
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Entity Type | Individual
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Provider Name | LATERIA NICOLE ALLEN M.ED., LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 10/29/2020
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 2302 DAWSON ROAD SUITE 102
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City | ALBANY
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State | GA
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Zip | 31707
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Country | US
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Telephone | 229-329-1580
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 491
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City | LEESBURG
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State | GA
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Zip | 31763-0491
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Country | US
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Telephone | 229-269-6821
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC014557
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC014557
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License Number State | GA
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