Provider Demographics
NPI:1215253950
Name:ALLEN, ANGEL NICOLE
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:NICOLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 CHESWICK DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8652
Mailing Address - Country:US
Mailing Address - Phone:336-451-7511
Mailing Address - Fax:
Practice Address - Street 1:3230 CHESWICK DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8652
Practice Address - Country:US
Practice Address - Phone:336-451-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health