MEDICARE: VIRGINIA VAN ALLEN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW002630	GA

General Provider Information

NPI Number	:	1770605818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA VAN ALLEN LCSW

Provider Business Mailing Address
First Line	:	685 ARGONNE AVE NE
Second Line	:	UNIT 2
City	:	ATLANTA
State	:	GA
Zip	:	30308-2036
Country	:	US
Telephone Number	:	678-665-5153
Fax Number	:	770-390-0877

Provider Business Practice Location Address
First Line	:	1 DUNWOODY PARK
Second Line	:	SUITE 140
City	:	ATLANTA
State	:	GA
Zip	:	30338-7404
Country	:	US
Telephone Number	:	678-665-5153
Fax Number	:	770-390-0877

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	07/08/2007

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