Provider Demographics
NPI:1083803456
Name:ALLEN, JOHN P
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:ALLEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 CARRIAGE COURT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-2923
Mailing Address - Country:US
Mailing Address - Phone:703-281-0760
Mailing Address - Fax:703-281-0760
Practice Address - Street 1:2009 CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22181-2923
Practice Address - Country:US
Practice Address - Phone:703-281-0760
Practice Address - Fax:703-281-0760
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical