Provider Demographics
NPI:1053020529
Name:ALLEN, DULCYANA LOUISE
Entity type:Individual
Prefix:
First Name:DULCYANA
Middle Name:LOUISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8292 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2354
Mailing Address - Country:US
Mailing Address - Phone:706-952-2800
Mailing Address - Fax:706-952-2802
Practice Address - Street 1:8292 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2354
Practice Address - Country:US
Practice Address - Phone:706-952-2800
Practice Address - Fax:706-952-2802
Is Sole Proprietor?:No
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01641101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)