Provider Demographics
NPI:1033603196
Name:D ALLEN AND DAVIS COMMUNITY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:D ALLEN AND DAVIS COMMUNITY COUNSELING CENTER, LLC
Other - Org Name:D ALLEN AND DAVIS COMMUNITY COUNSELING CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC, NCC
Authorized Official - Phone:240-416-6836
Mailing Address - Street 1:2670 CRAIN HWY STE 401
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2818
Mailing Address - Country:US
Mailing Address - Phone:240-416-6836
Mailing Address - Fax:240-419-2495
Practice Address - Street 1:2670 CRAIN HWY STE 401
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2818
Practice Address - Country:US
Practice Address - Phone:240-416-6836
Practice Address - Fax:240-419-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC87113261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)