Provider Demographics
NPI:1861903080
Name:ALLEN, CELIA K (LLPC)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:K
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:CELIA
Other - Middle Name:K
Other - Last Name:KOWALCZYK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:16129 KENNEBEC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2108
Mailing Address - Country:US
Mailing Address - Phone:313-320-4478
Mailing Address - Fax:
Practice Address - Street 1:13101 ALLEN RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2216
Practice Address - Country:US
Practice Address - Phone:734-785-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-15
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health