Provider Demographics
NPI:1265024277
Name:ALLEN, LAKITA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LAKITA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330B PELHAM RD STE 210
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3116
Mailing Address - Country:US
Mailing Address - Phone:864-332-9956
Mailing Address - Fax:
Practice Address - Street 1:330 PELHAM ROAD
Practice Address - Street 2:BUILDING B, SUITE 210
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4046
Practice Address - Country:US
Practice Address - Phone:864-332-9956
Practice Address - Fax:864-841-8958
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8790101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC2717Medicaid