Provider Demographics
NPI:1013087816
Name:ALLIANCE COMMUNITY COUNSELING CENTER
Entity Type:Organization
Organization Name:ALLIANCE COMMUNITY COUNSELING CENTER
Other - Org Name:ALLIANCE COUNSELING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARNY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:408-293-4489
Mailing Address - Street 1:1040 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3150
Mailing Address - Country:US
Mailing Address - Phone:408-293-4489
Mailing Address - Fax:408-293-6188
Practice Address - Street 1:1040 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3150
Practice Address - Country:US
Practice Address - Phone:408-293-4489
Practice Address - Fax:408-293-6188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT & LCSW IN GROUP101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty