Organization
FAMILY CENTERED SERVICES OF ALASKA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELIE MARIE LARA (YOUTH COUNSELOR)
(915) 731-5160
Entity
Organization
Contact information
Practice address
1825 MARIKA RD, FAIRBANKS, FAIRBANKS, AK 99709-5521
(907) 474-0890
Mailing address
1825 MARIKA RD, FAIRBANKS, FAIRBANKS, AK 99709-5521
(907) 474-0890
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
10Y00000X
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MH3237
—
AK
Enumeration date
03/20/2014
Last updated
03/20/2014
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