Provider Demographics
NPI:1821421173
Name:PRICE, JAMES M (LPC, CDC II, MAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:PRICE
Suffix:
Gender:M
Credentials:LPC, CDC II, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 E REZANOF DR
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6952
Mailing Address - Country:US
Mailing Address - Phone:907-486-7385
Mailing Address - Fax:907-486-7398
Practice Address - Street 1:3449 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6952
Practice Address - Country:US
Practice Address - Phone:907-486-7385
Practice Address - Fax:907-486-7398
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3962101YA0400X
AK163166101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK163166OtherALASKA LICENSED PROFESSIONAL COUNSELOR
AKMH2237Medicaid