Provider Demographics
NPI:1427031392
Name:ALLEN, MARGUERITE A (DMIN, LCMHCS, LCASA)
Entity Type:Individual
Prefix:MS
First Name:MARGUERITE
Middle Name:A
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DMIN, LCMHCS, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1702
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1702
Mailing Address - Country:US
Mailing Address - Phone:980-446-0004
Mailing Address - Fax:980-272-0446
Practice Address - Street 1:110 STOCKTON ST STE M
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5253
Practice Address - Country:US
Practice Address - Phone:980-446-0004
Practice Address - Fax:980-272-0446
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1675101YP2500X
NC7551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000990300Medicaid
NC6104321Medicaid