Provider Demographics
NPI:1083269922
Name:ALLEN, AMELIA MARIAH (LLMSW)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:MARIAH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13511 ARCHDALE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1335
Mailing Address - Country:US
Mailing Address - Phone:313-694-5412
Mailing Address - Fax:
Practice Address - Street 1:13511 ARCHDALE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-1335
Practice Address - Country:US
Practice Address - Phone:313-694-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103574104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker