Provider Demographics
NPI:1396475372
Name:ALLEN, MIRANDA ELIZABETH (NCPSS)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ELIZABETH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:NCPSS
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:ELIZABETH
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NCPSS
Mailing Address - Street 1:482 DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-2303
Mailing Address - Country:US
Mailing Address - Phone:828-201-0210
Mailing Address - Fax:
Practice Address - Street 1:4010 LITTLEJOHN CHURCH RD
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-8563
Practice Address - Country:US
Practice Address - Phone:828-201-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-6851-01175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist