Provider Demographics
NPI:1528659190
Name:ALLEN, ELIZABETH RICHARDSON (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:RICHARDSON
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-302-8680
Mailing Address - Fax:980-302-8681
Practice Address - Street 1:6324 FAIRVIEW RD STE 310
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-4172
Practice Address - Country:US
Practice Address - Phone:980-302-8680
Practice Address - Fax:980-302-8681
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0121291041C0700X
AR2003-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC012129OtherSOCIAL WORK LICENSE
AR2033-COtherSOCIAL WORK LICENSE