Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 7324 | SC |
NPI | 1053941898 |
---|---|
Provider Name | Mary Ashley Allen |
First Address | Greenville, SC 29608-4431 |
Second Address | Clemson, SC 29631-1401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2020 |
Last Update Date | 08/07/2020 |