Healthcare Provider Details

I. General information

NPI: 1467022665
Provider Name (Legal Business Name): ANAM CARA COUNSELING LICENSED PROFESSIONAL CLINICAL COUNSELOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W WASHINGTON AVE STE 205
SUNNYVALE CA
94086-1101
US

IV. Provider business mailing address

121 W WASHINGTON AVE STE 205
SUNNYVALE CA
94086-1101
US

V. Phone/Fax

Practice location:
  • Phone: 408-461-7222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SARAH HEACOCK
Title or Position: PRESIDENT
Credential: LPCC
Phone: 408-461-7222