Provider Demographics
NPI:1609200393
Name:ALLEN, DIANNE (MA CAP CET)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA CAP CET
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 664
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33780-0664
Mailing Address - Country:US
Mailing Address - Phone:727-824-5745
Mailing Address - Fax:
Practice Address - Street 1:647 34TH AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3730
Practice Address - Country:US
Practice Address - Phone:727-824-5745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 1186101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)