Provider Demographics
NPI:1710674007
Name:DALTON, ALLEEN
Entity Type:Individual
Prefix:MS
First Name:ALLEEN
Middle Name:
Last Name:DALTON
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 1:399 DESIREE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3644
Mailing Address - Country:US
Mailing Address - Phone:404-293-4133
Mailing Address - Fax:
Practice Address - Street 1:9000 SOUTHSIDE BLVD BLDG 900
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0791
Practice Address - Country:US
Practice Address - Phone:904-732-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-22-249567106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician