Provider Demographics
NPI:1417685959
Name:ALLEN, ANGELA RENAE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:RENAE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUSHMAN ST STE 308
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4673
Mailing Address - Country:US
Mailing Address - Phone:907-318-5686
Mailing Address - Fax:907-917-4166
Practice Address - Street 1:100 CUSHMAN ST STE 308
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4673
Practice Address - Country:US
Practice Address - Phone:907-318-5686
Practice Address - Fax:907-917-4166
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1556641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical