Provider Demographics
NPI:1396238234
Name:ALLWINE, ANNE MARIE LACKEY
Entity type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:LACKEY
Last Name:ALLWINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ORCHARDS RD
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4428
Mailing Address - Country:US
Mailing Address - Phone:603-569-3803
Mailing Address - Fax:
Practice Address - Street 1:23 ORCHARDS RD
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4428
Practice Address - Country:US
Practice Address - Phone:603-569-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical