Provider Demographics
NPI:1679757074
Name:COMMUNITY COUNSELING & EDUCATION CENTER
Entity Type:Organization
Organization Name:COMMUNITY COUNSELING & EDUCATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUMPHREYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-792-3129
Mailing Address - Street 1:3775 BEACON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-792-3129
Mailing Address - Fax:510-792-4928
Practice Address - Street 1:3775 BEACON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1465
Practice Address - Country:US
Practice Address - Phone:510-792-3129
Practice Address - Fax:510-792-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XOtherDRUG & ALCOHOL COUNSELOR