Provider Demographics
NPI:1740602549
Name:SANKOFA HOLISTIC COUNSELING SERVICES, A PROFESSIONAL CLINICAL SOCIAL W
Entity type:Organization
Organization Name:SANKOFA HOLISTIC COUNSELING SERVICES, A PROFESSIONAL CLINICAL SOCIAL W
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-433-0244
Mailing Address - Street 1:614 GRAND AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-3554
Mailing Address - Country:US
Mailing Address - Phone:510-433-0244
Mailing Address - Fax:
Practice Address - Street 1:614 GRAND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3554
Practice Address - Country:US
Practice Address - Phone:510-433-0244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS250621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty