Provider Demographics
NPI:1770605818
Name:ALLEN, VIRGINIA VAN (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:VAN
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:685 ARGONNE AVE NE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2036
Mailing Address - Country:US
Mailing Address - Phone:678-665-5153
Mailing Address - Fax:770-390-0877
Practice Address - Street 1:1 DUNWOODY PARK
Practice Address - Street 2:SUITE 140
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7404
Practice Address - Country:US
Practice Address - Phone:678-665-5153
Practice Address - Fax:770-390-0877
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0026301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical