Provider Demographics
NPI:1164859351
Name:DAWN AND ALICE COUNSELING SERVICE
Entity Type:Organization
Organization Name:DAWN AND ALICE COUNSELING SERVICE
Other - Org Name:D.N.A. COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-274-0030
Mailing Address - Street 1:5185 CAMINO AL NORTE STE 120
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2416
Mailing Address - Country:US
Mailing Address - Phone:702-600-9433
Mailing Address - Fax:
Practice Address - Street 1:5185 CAMINO AL NORTE STE 120
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2416
Practice Address - Country:US
Practice Address - Phone:702-600-9433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV251B00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV272211680Medicaid