Provider Demographics
NPI:1669219812
Name:ALLEN, SARA L
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:L
Last Name:ALLEN
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 1:150 WESTPARK DR APT 822
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7500
Mailing Address - Country:US
Mailing Address - Phone:818-900-8098
Mailing Address - Fax:
Practice Address - Street 1:150 WESTPARK DR APT 822
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-7500
Practice Address - Country:US
Practice Address - Phone:818-900-8098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician