Provider Demographics
NPI:1467516427
Name:SUNNYBOY, AUDREY (TRAD COUNSELOR)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:SUNNYBOY
Suffix:
Gender:F
Credentials:TRAD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 COLLEGE RD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-1702
Mailing Address - Country:US
Mailing Address - Phone:907-455-4611
Mailing Address - Fax:907-374-8303
Practice Address - Street 1:59 COLLEGE RD
Practice Address - Street 2:SUITE 213
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-1702
Practice Address - Country:US
Practice Address - Phone:907-455-4611
Practice Address - Fax:907-374-8303
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2357101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)