Provider Demographics
NPI:1699254813
Name:ALLEN, GLORIA JEAN (LSW/MSW)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LSW/MSW
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:J
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW/MSW
Mailing Address - Street 1:423 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4132
Mailing Address - Country:US
Mailing Address - Phone:130-712-6074
Mailing Address - Fax:800-977-8573
Practice Address - Street 1:423 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4132
Practice Address - Country:US
Practice Address - Phone:130-712-6074
Practice Address - Fax:800-977-8573
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
APOO943402104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker