Individual
VIVIETTE L. ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1540 PURDUE DR, SUITE 200, FAYETTEVILLE, NC 28303-5510
(910) 867-8889
Mailing address
1318 RAEFORD RD, STE 1, FAYETTEVILLE, NC 28305-5096
(910) 867-8889
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
1708
NC
1041C0700X
Clinical Social Worker
COO1142
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10588
BCBS
NC
01
—
344141
MHN TRICARE
NC
05
—
6002468
—
NC
01
—
MEDCOST
MEDCOST
NC
Enumeration date
12/21/2006
Last updated
02/23/2017
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