Provider Demographics
NPI:1710271879
Name:ALLEN, ANGELA LORRAINE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LORRAINE
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 1:536 SAINT LOUIS AVE
Mailing Address - Street 2:#1
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-3392
Mailing Address - Country:US
Mailing Address - Phone:562-346-6678
Mailing Address - Fax:
Practice Address - Street 1:369 W COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3110
Practice Address - Country:US
Practice Address - Phone:310-603-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARS6194101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)