Provider Demographics
NPI:1114799228
Name:ALLEN, NENA MICHELLE
Entity Type:Individual
Prefix:
First Name:NENA
Middle Name:MICHELLE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NENA
Other - Middle Name:MICHELLE
Other - Last Name:DYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 BIANCA CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-6652
Mailing Address - Country:US
Mailing Address - Phone:803-833-0578
Mailing Address - Fax:
Practice Address - Street 1:124 BIANCA CT
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-6652
Practice Address - Country:US
Practice Address - Phone:803-833-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician