Provider Demographics
NPI:1467556670
Name:ALLEN, ANNE M (LPC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPC
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 284
Mailing Address - Street 2:
Mailing Address - City:AYLETT
Mailing Address - State:VA
Mailing Address - Zip Code:23009-0284
Mailing Address - Country:US
Mailing Address - Phone:804-769-7971
Mailing Address - Fax:804-769-0714
Practice Address - Street 1:5833 RICHMOND TAPPAHANNOCK HWY
Practice Address - Street 2:SUITE 108-B
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009-3007
Practice Address - Country:US
Practice Address - Phone:804-769-7971
Practice Address - Fax:804-769-0714
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005412722Medicaid
VA005412714Medicaid