Provider Demographics
NPI:1427590306
Name:COMMUNITY COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-764-6997
Mailing Address - Street 1:5150 SUNRISE BLVD
Mailing Address - Street 2:SUITE H-1
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4939
Mailing Address - Country:US
Mailing Address - Phone:916-965-5015
Mailing Address - Fax:
Practice Address - Street 1:5150 SUNRISE BLVD
Practice Address - Street 2:SUITE H-1
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4939
Practice Address - Country:US
Practice Address - Phone:916-565-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT21311101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty