Provider Demographics
NPI:1487886131
Name:GOVAIN, ALONZO DONELL SR (COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:ALONZO
Middle Name:DONELL
Last Name:GOVAIN
Suffix:SR
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 CONTRA COSTA AVENUE.
Mailing Address - Street 2:K106
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-4001
Mailing Address - Country:US
Mailing Address - Phone:510-685-3703
Mailing Address - Fax:888-411-0139
Practice Address - Street 1:1330 CONTRA COSTA AVENUE.
Practice Address - Street 2:K106
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-4001
Practice Address - Country:US
Practice Address - Phone:510-685-3703
Practice Address - Fax:888-411-0139
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI3570212101YA0400X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)