Provider Demographics
NPI:1720266612
Name:ALLEN-HENDERSON, FRANCES ANN (MA, LSW, LPC, ALPS)
Entity Type:Individual
Prefix:MS
First Name:FRANCES
Middle Name:ANN
Last Name:ALLEN-HENDERSON
Suffix:
Gender:F
Credentials:MA, LSW, LPC, ALPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 345
Mailing Address - Street 2:
Mailing Address - City:FAIRDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25839-0345
Mailing Address - Country:US
Mailing Address - Phone:304-934-5950
Mailing Address - Fax:304-934-5961
Practice Address - Street 1:1197 SAXON RD.
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:WV
Practice Address - Zip Code:25839-0345
Practice Address - Country:US
Practice Address - Phone:304-934-5950
Practice Address - Fax:304-934-5961
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010939Medicaid