Provider Demographics
NPI:1659462554
Name:ALLEN, TRENIA L (LCSW)
Entity Type:Individual
Prefix:
First Name:TRENIA
Middle Name:L
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 1:501 AVALON WAY
Mailing Address - Street 2:STE D
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7500
Mailing Address - Country:US
Mailing Address - Phone:601-951-9863
Mailing Address - Fax:601-487-8897
Practice Address - Street 1:1606 TWIN OAKS DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3941
Practice Address - Country:US
Practice Address - Phone:601-201-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC52261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00883564Medicaid