Provider Demographics
NPI:1538872452
Name:ALLEN, ARTEMIS RAY (LPC)
Entity type:Individual
Prefix:
First Name:ARTEMIS
Middle Name:RAY
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-5521
Mailing Address - Country:US
Mailing Address - Phone:912-662-6282
Mailing Address - Fax:
Practice Address - Street 1:24 W HENRY ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31401-6719
Practice Address - Country:US
Practice Address - Phone:912-662-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty