Provider Demographics
NPI:1154685790
Name:ALLEN, MARISA ANN
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:ANN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N JOHNSON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1650
Mailing Address - Country:US
Mailing Address - Phone:619-337-3830
Mailing Address - Fax:
Practice Address - Street 1:1400 N JOHNSON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1650
Practice Address - Country:US
Practice Address - Phone:619-337-3830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)