Provider Demographics
NPI:1881318012
Name:ANCHORED CALIFORNIA LICENSED PROFESSIONAL CLINICAL COUNSELOR, INC.
Entity type:Organization
Organization Name:ANCHORED CALIFORNIA LICENSED PROFESSIONAL CLINICAL COUNSELOR, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC LPC
Authorized Official - Phone:707-688-8859
Mailing Address - Street 1:419 GEORGIA ST STE 11
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-6046
Mailing Address - Country:US
Mailing Address - Phone:707-652-5442
Mailing Address - Fax:
Practice Address - Street 1:419 GEORGIA ST STE 11
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-6046
Practice Address - Country:US
Practice Address - Phone:707-652-5442
Practice Address - Fax:707-651-9426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-30
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty