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General NPI Number Information
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NPI Number | 1720872450
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Entity Type | Individual
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Provider Name | ANTHONY M ALLEN
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Gender | Male
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Dates
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Enumeration Date | 04/07/2025
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 7025 HARBOUR VIEW BLVD
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City | SUFFOLK
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State | VA
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Zip | 23435-2761
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Country | US
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Telephone | 757-758-5106
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Fax |
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Provider Business Mailing Address
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Address Line | 4011 RAVINE GAP DR
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City | SUFFOLK
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State | VA
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Zip | 23434-3051
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Country | US
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Telephone | 757-235-3859
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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 | 0704015305
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License Number State | VA
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