Provider Demographics
NPI:1073864237
Name:ALLEN, MEGAN (CSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CSW
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 250
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-0250
Mailing Address - Country:US
Mailing Address - Phone:770-667-3877
Mailing Address - Fax:770-667-3877
Practice Address - Street 1:3903 S COBB DR SE
Practice Address - Street 2:SUITE 235
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8504
Practice Address - Country:US
Practice Address - Phone:770-667-3877
Practice Address - Fax:770-667-3879
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0043471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical