Provider Demographics
NPI:1386796100
Name:ALLEN, JUDITH (LPC)
Entity type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E 5TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-3031
Mailing Address - Country:US
Mailing Address - Phone:704-367-2736
Mailing Address - Fax:704-943-3548
Practice Address - Street 1:601 E 5TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-3031
Practice Address - Country:US
Practice Address - Phone:704-367-2736
Practice Address - Fax:704-943-3548
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional