Individual
JENNIFER BURLESON ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED
Contact information
Practice address
4232 SHOPTON RD, CHARLOTTE, NC 28217-3016
(704) 222-7561
Mailing address
212 COOPER DR, CHARLOTTE, NC 28210-2824
(704) 222-7561
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
9195
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1265838122
NPI TYPE II
NC
Enumeration date
03/30/2017
Last updated
03/30/2017
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