Individual
PHYLLIS A ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4010 N MAIN ST, SUITE 2, COLUMBIA, SC 29203-5848
(803) 786-0559
(803) 786-1307
Mailing address
4010 N MAIN ST, SUITE 2, COLUMBIA, SC 29203-5848
(803) 786-0559
(803) 786-1307
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
3
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3
LICENSE NUMBER
SC
Enumeration date
06/10/2013
Last updated
06/10/2013
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