Provider Demographics
NPI:1285060012
Name:ALLEN, DANETTE (LCSW)
Entity type:Individual
Prefix:
First Name:DANETTE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 N CROSSOVER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4591
Mailing Address - Country:US
Mailing Address - Phone:479-521-1427
Mailing Address - Fax:479-521-6520
Practice Address - Street 1:1400 COLLEGE DR STE 204
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3575
Practice Address - Country:US
Practice Address - Phone:903-791-1110
Practice Address - Fax:903-791-9353
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX64755OtherTX LICENSE
AR6902-COtherAR LICENSE