Provider Demographics
NPI:1205160876
Name:ALLEN, WENDEL (CAC-M CSOTS)
Entity type:Individual
Prefix:MR
First Name:WENDEL
Middle Name:
Last Name:ALLEN
Suffix:
Gender:M
Credentials:CAC-M CSOTS
Other - Prefix:MR
Other - First Name:WENDEL
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8097 DECATUR
Mailing Address - Street 2:
Mailing Address - City:DERTROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-2741
Mailing Address - Country:US
Mailing Address - Phone:313-846-5020
Mailing Address - Fax:313-846-3468
Practice Address - Street 1:8097 DECATUR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-2721
Practice Address - Country:US
Practice Address - Phone:313-846-5020
Practice Address - Fax:313-846-3468
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)