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General NPI Number Information
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NPI Number | 1669861357
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Entity Type | Individual
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Provider Name | MICHOLE J ALLEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/18/2015
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 912 KILLIAN HILL RD SW SUITE 202-C
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City | LILBURN
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State | GA
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Zip | 30047-3110
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Country | US
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Telephone | 404-626-5962
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Fax |
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Provider Business Mailing Address
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Address Line | 2850 PARKWAY CLOSE
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City | LITHONIA
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State | GA
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Zip | 30058-4643
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Country | US
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Telephone | 404-626-5962
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW005010
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License Number State | GA
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