Provider Demographics
NPI:1669861357
Name:ALLEN, MICHOLE J (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MICHOLE
Middle Name:J
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 1:2850 PARKWAY CLOSE
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4643
Mailing Address - Country:US
Mailing Address - Phone:404-626-5962
Mailing Address - Fax:
Practice Address - Street 1:912 KILLIAN HILL RD SW
Practice Address - Street 2:SUITE 202-C
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3110
Practice Address - Country:US
Practice Address - Phone:404-626-5962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-18
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0050101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical