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General NPI Number Information
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NPI Number | 1942364997
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Entity Type | Organization
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Legal Business Name | SUNNY DENYAAVEE CENTER
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 59 COLLEGE RD SUITE 213
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City | FAIRBANKS
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State | AK
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Zip | 99701-1702
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Country | US
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Telephone | 907-455-4611
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Fax | 907-374-8303
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Provider Business Mailing Address
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Address Line | 59 COLLEGE RD SUITE 213
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City | FAIRBANKS
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State | AK
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Zip | 99701-1702
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Country | US
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Telephone | 907-455-4611
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Fax | 907-374-8303
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | AUDREY SUNNYBOY
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Credential |
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Telephone | 907-455-4611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 712170
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License Number State | AK
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