Provider Demographics
NPI:1194859850
Name:CENTER FOR PSYCHOSOCIAL DEVELOPMENT INC
Entity type:Organization
Organization Name:CENTER FOR PSYCHOSOCIAL DEVELOPMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROWLEY-SIPPLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:907-646-0707
Mailing Address - Street 1:1410 RUDAKOF CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3106
Mailing Address - Country:US
Mailing Address - Phone:907-646-0707
Mailing Address - Fax:907-600-5124
Practice Address - Street 1:1410 RUDAKOF CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3106
Practice Address - Country:US
Practice Address - Phone:907-646-0707
Practice Address - Fax:907-600-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK51575D251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC7089Medicaid