Provider Demographics
NPI:1508606278
Name:ALLEN, DEMETRIA RONADA (LPCA)
Entity type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:RONADA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DONALDSON DR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-8709
Mailing Address - Country:US
Mailing Address - Phone:843-812-3339
Mailing Address - Fax:
Practice Address - Street 1:15 DONALDSON DR
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-8709
Practice Address - Country:US
Practice Address - Phone:843-812-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health