Provider Demographics
NPI:1659315547
Name:ALPINE CHRISTIAN COUNSELING ASSOCIATES, INC
Entity type:Organization
Organization Name:ALPINE CHRISTIAN COUNSELING ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:209-465-4165
Mailing Address - Street 1:2808 CALARIVA DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-1407
Mailing Address - Country:US
Mailing Address - Phone:209-465-4165
Mailing Address - Fax:209-465-4165
Practice Address - Street 1:2307 W ALPINE AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-2701
Practice Address - Country:US
Practice Address - Phone:209-942-3369
Practice Address - Fax:209-465-4165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22242106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty