Provider Demographics
NPI:1548992274
Name:ALLEN, SHRETA (LCSW-A)
Entity type:Individual
Prefix:
First Name:SHRETA
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 ADAM D MYERS RD
Mailing Address - Street 2:
Mailing Address - City:PAGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29728-7139
Mailing Address - Country:US
Mailing Address - Phone:843-517-0616
Mailing Address - Fax:
Practice Address - Street 1:119 FUCHIA LN
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4287
Practice Address - Country:US
Practice Address - Phone:704-201-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0177631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical