Provider Demographics
NPI:1194595702
Name:AUTHENTIC ALLIANCE, A LICENSED CLINICAL SOCIAL WORKER P.C.
Entity type:Organization
Organization Name:AUTHENTIC ALLIANCE, A LICENSED CLINICAL SOCIAL WORKER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LAHANA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-915-4795
Mailing Address - Street 1:248 3RD ST UNIT 5045
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4375
Mailing Address - Country:US
Mailing Address - Phone:707-596-9696
Mailing Address - Fax:
Practice Address - Street 1:445 BELLEVUE AVE STE 104A
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4923
Practice Address - Country:US
Practice Address - Phone:707-596-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty