Provider Demographics
NPI:1790896959
Name:ALLEN, DOROTHY TEBBUTT (MA LPA)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:TEBBUTT
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MA LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 RAYBURN AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587
Mailing Address - Country:US
Mailing Address - Phone:919-818-8249
Mailing Address - Fax:
Practice Address - Street 1:1725 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-556-6501
Practice Address - Fax:919-556-4933
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046MHOtherNC HEALTH CHOICE
NC8375OtherFIVE COUNTY MENTAL HEALTH
NC6107138Medicaid