Provider Demographics
NPI:1093966087
Name:ALLEN, MICHELLE JEANNINE (LAPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JEANNINE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N TENNESSEE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-8514
Mailing Address - Country:US
Mailing Address - Phone:770-386-0776
Mailing Address - Fax:678-279-9950
Practice Address - Street 1:911 N TENNESSEE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8514
Practice Address - Country:US
Practice Address - Phone:770-386-0776
Practice Address - Fax:678-279-9950
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2012-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002101101YM0800X
GALPC006478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003122047AMedicaid