Provider Demographics
NPI:1346019023
Name:ALLEN, CAROLYN JO ANN
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:JO 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 1:3609 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3340
Mailing Address - Country:US
Mailing Address - Phone:678-933-6437
Mailing Address - Fax:
Practice Address - Street 1:3609 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3340
Practice Address - Country:US
Practice Address - Phone:678-933-6437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA446401-001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services