Healthcare Provider Details

I. General information

NPI: 1437796851
Provider Name (Legal Business Name): ALLEN TEMPLE HEALTH & SOCIAL SERVICES MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 INTERNATIONAL BLVD., C-105
OAKLAND CA
94621-1549
US

IV. Provider business mailing address

8501 INTERNATIONAL BLVD., C-105
OAKLAND CA
94621-1549
US

V. Phone/Fax

Practice location:
  • Phone: 510-544-8947
  • Fax: 510-544-8918
Mailing address:
  • Phone: 510-544-8947
  • Fax: 510-544-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: GLORIA CROWELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 510-544-8947