Basic Information
| Provider Information | |||||||||
| NPI: | 1558494823 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLRED | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | WHEELER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMFT, MA, M.DIV. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 28 | ||||||||
| Address2: | |||||||||
| City: | LAMBSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243510028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2762389828 | ||||||||
| FaxNumber: | 3367149111 | ||||||||
| Practice Location | |||||||||
| Address1: | 351 RIVERSIDE DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT AIRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270303850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367836919 | ||||||||
| FaxNumber: | 3367836923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 227 | NC | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.