Provider Demographics
NPI:1952386070
Name:ALLEN, GERALD L (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:L
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5927 FRYE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9605
Mailing Address - Country:US
Mailing Address - Phone:336-971-8768
Mailing Address - Fax:336-748-4081
Practice Address - Street 1:125 ASHLEYBROOK LN
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2957
Practice Address - Country:US
Practice Address - Phone:336-971-8768
Practice Address - Fax:336-748-4147
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0014271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical