Provider Demographics
NPI:1780258012
Name:ALLENDORF, LANETTE (LCMHC, CCM)
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:
Last Name:ALLENDORF
Suffix:
Gender:F
Credentials:LCMHC, CCM
Other - Prefix:
Other - First Name:LANETTE
Other - Middle Name:
Other - Last Name:PEMBERTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:300 BENT OAK DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-5005
Mailing Address - Country:US
Mailing Address - Phone:817-253-6244
Mailing Address - Fax:
Practice Address - Street 1:300 BENT OAK DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-5005
Practice Address - Country:US
Practice Address - Phone:817-253-6244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health