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NPI Code Detail

MEDICARE: AYANNA DENEE FORKS

MEDICARE: AYANNA DENEE FORKS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care CoordinatorCA
3101YP2500XProfessional Counselor21968CA

General Provider Information

NPI Number : 1285086942
Entity Type Code : Individual
Provider Name (Legal Business Name) : AYANNA DENEE FORKS
Provider Business Mailing Address
First Line : 5325 BRODER BLVD
Second Line :
City : DUBLIN
State : CA
Zip : 94568-3309
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5325 BRODER BLVD
Second Line :
City : DUBLIN
State : CA
Zip : 94568-3309
Country : US
Telephone Number : 408-220-5145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2016
Last Update Date : 02/27/2026

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Directions to “ AYANNA DENEE FORKS ” Practice Location

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