Provider Demographics
NPI:1396958914
Name:PHAKEOVILAY, FRANK (COUNSELOR II AOD-CER)
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:
Last Name:PHAKEOVILAY
Suffix:
Gender:M
Credentials:COUNSELOR II AOD-CER
Other - Prefix:MR
Other - First Name:FRANK
Other - Middle Name:
Other - Last Name:PHAKEOVILAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CASII (03-048024)
Mailing Address - Street 1:7200 BANCROFT AVENUE SUITE 176
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605
Mailing Address - Country:US
Mailing Address - Phone:510-568-2432
Mailing Address - Fax:510-568-3912
Practice Address - Street 1:7200 BANCROFT AVENUE SUITE 176
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605
Practice Address - Country:US
Practice Address - Phone:510-568-2432
Practice Address - Fax:510-568-3912
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-048024101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA010006DNMedicare UPIN