Provider Demographics
NPI:1013109289
Name:ALLEN, JAMES B (MACNS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:B
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MACNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MILLPLACE CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7768
Mailing Address - Country:US
Mailing Address - Phone:803-407-6916
Mailing Address - Fax:
Practice Address - Street 1:455 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4486
Practice Address - Country:US
Practice Address - Phone:803-315-8525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional