Provider Demographics
NPI:1497892483
Name:DALAFAVE, ALLEN SEAN (LCSW)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:SEAN
Last Name:DALAFAVE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 RAMAH TRL SW
Mailing Address - Street 2:
Mailing Address - City:MC CALL CREEK
Mailing Address - State:MS
Mailing Address - Zip Code:39647-8004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1302 LEE AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39407-0001
Practice Address - Country:US
Practice Address - Phone:601-558-2547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC80461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical