Provider Demographics
NPI:1518387612
Name:FAIRBANKS COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FAIRBANKS COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:907-451-1800
Mailing Address - Street 1:250 CUSHMAN ST
Mailing Address - Street 2:STE 4F
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4640
Mailing Address - Country:US
Mailing Address - Phone:907-451-1800
Mailing Address - Fax:907-451-3755
Practice Address - Street 1:250 CUSHMAN ST
Practice Address - Street 2:STE 4F
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4640
Practice Address - Country:US
Practice Address - Phone:907-451-1800
Practice Address - Fax:907-451-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK9041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty