Provider Demographics
NPI:1215284906
Name:ALLEN, KATIE TART (PSYD)
Entity type:Individual
Prefix:DR
First Name:KATIE
Middle Name:TART
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 EXECUTIVE CIR STE 6
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4575
Mailing Address - Country:US
Mailing Address - Phone:404-480-0332
Mailing Address - Fax:919-551-7569
Practice Address - Street 1:1148 EXECUTIVE CIR STE 6
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4575
Practice Address - Country:US
Practice Address - Phone:404-480-0332
Practice Address - Fax:919-551-7569
Is Sole Proprietor?:No
Enumeration Date:2012-08-13
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003583103T00000X
NC4833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist