Provider Demographics
NPI:1871838235
Name:ALLEN, ECCLESIASTES (LCSW, PIP)
Entity Type:Individual
Prefix:
First Name:ECCLESIASTES
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 DOUGLASS RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806-2280
Mailing Address - Country:US
Mailing Address - Phone:256-617-3845
Mailing Address - Fax:
Practice Address - Street 1:284 DOUGLASS RD NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2280
Practice Address - Country:US
Practice Address - Phone:256-617-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2145-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical