Provider Demographics
NPI:1083269922
Name:ALLEN, AMELIA MARIAH (LMSW)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MARIAH
Last Name:ALLEN
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13511 ARCHDALE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1335
Mailing Address - Country:US
Mailing Address - Phone:313-694-5412
Mailing Address - Fax:
Practice Address - Street 1:12421 FIRST AVE S
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3541
Practice Address - Country:US
Practice Address - Phone:313-694-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801114871104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker