Basic Information
| Provider Information | |||||||||
| NPI: | 1396913166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MSW, LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 284 EXECUTIVE PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280251894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049391100 | ||||||||
| FaxNumber: | 7049391173 | ||||||||
| Practice Location | |||||||||
| Address1: | 227 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273713058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105723681 | ||||||||
| FaxNumber: | 9105725579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2008 | ||||||||
| LastUpdateDate: | 07/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | C004803 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 141E2 | 01 | NC | BCBS | OTHER | 185337 | 01 | NC | MEDCOST | OTHER | 6002931 | 05 | NC | MEDICAID |