=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063337038
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEYANA EHLAZHIA ALLRED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2026
-----------------------------------------------------
Last Update Date | 08/13/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 523 ROCKINGHAM RD
-----------------------------------------------------
City | ROCKINGHAM
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28379-3615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-562-9882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 410 RIDGE DR
-----------------------------------------------------
City | HAMLET
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28345-4553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 472-265-3700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | P024095
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------