Provider Demographics
NPI:1851763957
Name:ALLEN, KATHY SUE (BS, CSAC,SAP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:SUE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:BS, CSAC,SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 E MARION ST STE A
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4740
Mailing Address - Country:US
Mailing Address - Phone:980-230-9967
Mailing Address - Fax:855-537-0363
Practice Address - Street 1:941 E MARION ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4740
Practice Address - Country:US
Practice Address - Phone:980-230-9967
Practice Address - Fax:855-537-0363
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCSAC 13016101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)