Provider Demographics
NPI:1114412863
Name:ALLEN, ADAM LEE (MS, BCBA)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:LEE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2824 HILLCREEK DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5628
Mailing Address - Country:US
Mailing Address - Phone:706-826-2770
Mailing Address - Fax:706-826-2771
Practice Address - Street 1:2824 HILLCREEK DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-826-2770
Practice Address - Fax:706-826-2771
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-18-31067103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst