=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811312507
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAMEDA COUNSELING ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2014
-----------------------------------------------------
Last Update Date | 03/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 PARK ST SUITE 220
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-227-6404
-----------------------------------------------------
Fax | 510-227-6408
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1700 PARK ST SUITE 220
-----------------------------------------------------
City | ALAMEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94501-1416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-227-6404
-----------------------------------------------------
Fax | 510-227-6408
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AUDREA C. BUTLER ACUNA
-----------------------------------------------------
Credential | MFT
-----------------------------------------------------
Telephone | 510-227-6404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 46716
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------