Provider Demographics
NPI:1336887306
Name:PRIME, ALLEN (CADC I)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:PRIME
Suffix:
Gender:M
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WALNUT AVE SE
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30147-1229
Mailing Address - Country:US
Mailing Address - Phone:551-333-0298
Mailing Address - Fax:
Practice Address - Street 1:204 WALNUT AVE SE
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:GA
Practice Address - Zip Code:30147-1229
Practice Address - Country:US
Practice Address - Phone:551-333-0298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)