Provider Demographics
NPI:1669041265
Name:ALLEN, THEODORE CRITTENDON (APC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:CRITTENDON
Last Name:ALLEN
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2413
Mailing Address - Country:US
Mailing Address - Phone:404-409-0413
Mailing Address - Fax:
Practice Address - Street 1:345 W MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2413
Practice Address - Country:US
Practice Address - Phone:912-785-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health