MEDICARE: CHRISTINE ALLEN LPC-I

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	101YP2500X	Professional Counselor	5626	SC

General Provider Information

NPI Number	:	1790025153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ALLEN LPC-I

Provider Business Mailing Address
First Line	:	12 EXECUTIVE CT
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-9338
Country	:	US
Telephone Number	:	803-295-0005
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 EXECUTIVE CT
Second Line	:
City	:	LAKE WYLIE
State	:	SC
Zip	:	29710-9338
Country	:	US
Telephone Number	:	803-295-0005
Fax Number	:

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

Provider Enumeration Date	:	02/22/2013
Last Update Date	:	02/22/2013

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Directions to “ CHRISTINE ALLEN LPC-I” Practice Location

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