Healthcare Provider Details

I. General information

NPI: 1235558016
Provider Name (Legal Business Name): ALASKA FULL CIRCLE COUNSELING SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 E SWANSON AVE
WASILLA AK
99654-7025
US

IV. Provider business mailing address

133 E SWANSON AVE
WASILLA AK
99654-7025
US

V. Phone/Fax

Practice location:
  • Phone: 907-864-0560
  • Fax: 907-864-0564
Mailing address:
  • Phone: 907-864-0560
  • Fax: 907-864-0564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JEFFREY VEREIDE
Title or Position: PROGRAM MANAGER
Credential:
Phone: 907-357-7962