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General NPI Number Information
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NPI Number | 1093534836
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Entity Type | Individual
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Provider Name | ALLEN KENNETH CHALK MS,CAP
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Gender | Male
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 1251 N STONE ST
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City | DELAND
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State | FL
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Zip | 32720-2584
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Country | US
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Telephone | 386-623-3361
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Fax |
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Provider Business Mailing Address
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Address Line | 36927 SLICE LN
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City | GRAND ISLAND
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State | FL
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Zip | 32735-8449
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Country | US
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Telephone | 352-740-5517
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CAP.0100572
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License Number State | FL
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