Provider Demographics
NPI:1679260038
Name:ALLEN, ALEASE OLIVIA
Entity Type:Individual
Prefix:
First Name:ALEASE
Middle Name:OLIVIA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7375 EXECUTIVE PL STE 203
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6236
Mailing Address - Country:US
Mailing Address - Phone:202-207-0720
Mailing Address - Fax:
Practice Address - Street 1:7375 EXECUTIVE PL STE 203
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6236
Practice Address - Country:US
Practice Address - Phone:202-207-0720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician