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General NPI Number Information
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NPI Number | 1215325477
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Entity Type | Organization
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Legal Business Name | SUNRISE COUNSELING & THERAPY SERVICE LLP
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 12/22/2014
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Provider Practice Location Address
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Address Line | 626 2ND ST STE 303
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City | FAIRBANKS
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State | AK
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Zip | 99701-3466
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Country | US
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Telephone | 907-888-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 626 2ND ST STE 303
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City | FAIRBANKS
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State | AK
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Zip | 99701-3466
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Country | US
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Telephone | 907-888-7474
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DANA R PICTOU
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Credential | LPC
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Telephone | 907-888-7474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1014123
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License Number State | AK
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