Provider Demographics
NPI:1164889218
Name:ALLEN, VENUS E (LCASA, CCM)
Entity Type:Individual
Prefix:MRS
First Name:VENUS
Middle Name:E
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCASA, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8511 DAVIS LAKE PKWY STE C6-234
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0536
Mailing Address - Country:US
Mailing Address - Phone:919-807-1090
Mailing Address - Fax:800-465-8147
Practice Address - Street 1:10150 MALLARD CREEK RD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4507
Practice Address - Country:US
Practice Address - Phone:919-807-1090
Practice Address - Fax:800-465-8147
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-20
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC171M00000X, 101YA0400X, 1041C0700X, 101YP2500X, 171M00000X
101YM0800X
SC00000101YP2500X
NC0000171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional