Provider Demographics
NPI:1124432067
Name:ALLEN, THERESA C (MA, LPC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:C
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BROCK AVE
Mailing Address - Street 2:
Mailing Address - City:HONEA PATH
Mailing Address - State:SC
Mailing Address - Zip Code:29654-1423
Mailing Address - Country:US
Mailing Address - Phone:864-369-5172
Mailing Address - Fax:
Practice Address - Street 1:2315 N MAIN ST
Practice Address - Street 2:STE 211-F
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3880
Practice Address - Country:US
Practice Address - Phone:864-369-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional