Provider Demographics
NPI:1306381348
Name:ALLEN, LETISHA (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:LETISHA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 SHAMROCK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-2213
Mailing Address - Country:US
Mailing Address - Phone:704-201-0529
Mailing Address - Fax:
Practice Address - Street 1:121 E WATER ST
Practice Address - Street 2:#3
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2728
Practice Address - Country:US
Practice Address - Phone:704-240-3838
Practice Address - Fax:980-225-0537
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional