Provider Demographics
NPI:1619046273
Name:ALLEN, CHARLENE GAIL (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:GAIL
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 WESTERN AVE
Mailing Address - Street 2:DEPARTMENT 888182
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37921-5718
Mailing Address - Country:US
Mailing Address - Phone:865-544-0406
Mailing Address - Fax:865-544-0480
Practice Address - Street 1:2018 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921
Practice Address - Country:US
Practice Address - Phone:865-544-0406
Practice Address - Fax:865-544-0480
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLCD0000000034101YA0400X
TNLSW00000032731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN39224966Medicaid