Healthcare Provider Details

I. General information

NPI: 1366697575
Provider Name (Legal Business Name): ALLIANCE FAMILY SERVICES NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 S DIVISION AVE
SANDPOINT ID
83864-1749
US

IV. Provider business mailing address

608 S DIVISION AVE
SANDPOINT ID
83864-1749
US

V. Phone/Fax

Practice location:
  • Phone: 208-265-5049
  • Fax: 208-263-7515
Mailing address:
  • Phone: 208-265-5049
  • Fax: 208-263-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberLMSW-29175
License Number StateID

VIII. Authorized Official

Name: MRS. ALICIA ANN GABICA-GRAND
Title or Position: MENTAL HEALTH THERAPIST
Credential: LMSW
Phone: 208-265-5049