Provider Demographics
NPI:1467751370
Name:ALLEN, YAISA ATHEA (BA)
Entity Type:Individual
Prefix:
First Name:YAISA
Middle Name:ATHEA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 KIRKLAND RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-3317
Mailing Address - Country:US
Mailing Address - Phone:770-784-0076
Mailing Address - Fax:770-784-3036
Practice Address - Street 1:101 KIRKLAND RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-3317
Practice Address - Country:US
Practice Address - Phone:770-784-0076
Practice Address - Fax:770-784-3036
Is Sole Proprietor?:No
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health