Provider Demographics
NPI:1952053159
Name:ALLEN, THERESE MARIE (RBT)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:MARIE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 SUGARMILL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4494
Mailing Address - Country:US
Mailing Address - Phone:912-674-9894
Mailing Address - Fax:
Practice Address - Street 1:87009 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3400
Practice Address - Country:US
Practice Address - Phone:855-444-5664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician