Provider Demographics
NPI:1205314234
Name:ALLEN, LISA MARIE (CPSS, BS)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:CPSS, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 DUTCHMAN LN
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-9119
Mailing Address - Country:US
Mailing Address - Phone:803-402-5050
Mailing Address - Fax:
Practice Address - Street 1:205 PIEDMONT BLVD # 100
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1836
Practice Address - Country:US
Practice Address - Phone:803-323-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist