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General NPI Number Information
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NPI Number | 1366697575
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Entity Type | Organization
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Legal Business Name | ALLIANCE FAMILY SERVICES NORTH
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Dates
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Enumeration Date | 12/02/2008
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Last Update Date | 12/02/2008
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Provider Practice Location Address
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Address Line | 608 S DIVISION AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1749
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Country | US
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Telephone | 208-265-5049
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Fax | 208-263-7515
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Provider Business Mailing Address
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Address Line | 608 S DIVISION AVE
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City | SANDPOINT
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State | ID
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Zip | 83864-1749
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Country | US
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Telephone | 208-265-5049
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Fax | 208-263-7515
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | MRS. ALICIA ANN GABICA-GRAND
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Credential | LMSW
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Telephone | 208-265-5049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LMSW-29175
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License Number State | ID
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