Provider Demographics
NPI:1104400431
Name:ALLEN, PEGGY LARAINE (LGPC)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:LARAINE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23704 OCEAN GTWY
Mailing Address - Street 2:
Mailing Address - City:MARDELA SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:21837-2101
Mailing Address - Country:US
Mailing Address - Phone:410-742-7400
Mailing Address - Fax:410-742-6452
Practice Address - Street 1:23704 OCEAN GTWY
Practice Address - Street 2:
Practice Address - City:MARDELA SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:21837-2101
Practice Address - Country:US
Practice Address - Phone:410-742-7400
Practice Address - Fax:410-742-6452
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP11468101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health