Healthcare Provider Details

I. General information

NPI: 1285764001
Provider Name (Legal Business Name): SITKA COUNSELING & PREVENTION SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 METLAKATLA ST
SITKA AK
99835
US

IV. Provider business mailing address

113 METLAKATLA ST
SITKA AK
99835
US

V. Phone/Fax

Practice location:
  • Phone: 907-747-3636
  • Fax: 907-747-2702
Mailing address:
  • Phone: 907-747-3636
  • Fax: 907-747-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number298434
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number298434
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number298434
License Number StateAK

VIII. Authorized Official

Name: MS. AMY ZANUZOSKI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 907-747-3636