Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 004309 | GA |
NPI | 1457758229 |
---|---|
Provider Name | Kirsten Allen |
First Address | Atlanta, GA 30306-2127 |
Second Address | Atlanta, GA 30309-1304 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2014 |
Last Update Date | 07/08/2019 |