=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396572814
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN ALLEN COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2024
-----------------------------------------------------
Last Update Date | 09/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 N THORNTON AVE
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30720-4273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-275-8104
-----------------------------------------------------
Fax | 706-275-8134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 N THORNTON AVE
-----------------------------------------------------
City | DALTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30720-4273
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-275-8104
-----------------------------------------------------
Fax | 706-275-8134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | JOHN ALLEN
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 423-771-9536
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------