Provider Demographics
NPI:1881382059
Name:ALLIANCE COUNSELING AND FAMILY THERAPY
Entity type:Organization
Organization Name:ALLIANCE COUNSELING AND FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:910-595-6119
Mailing Address - Street 1:150 E FIRE TOWER RD STE C
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8330
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 E FIRE TOWER RD STE C
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8330
Practice Address - Country:US
Practice Address - Phone:910-595-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty