Provider Demographics
NPI:1720813397
Name:DANKENBRING, ALISON SHEA
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:SHEA
Last Name:DANKENBRING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:SHEA
Other - Last Name:GILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2305 LA PAZ CT APT 6
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-2316
Mailing Address - Country:US
Mailing Address - Phone:209-589-8002
Mailing Address - Fax:
Practice Address - Street 1:1904 RICHLAND AVE # C-1
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-4562
Practice Address - Country:US
Practice Address - Phone:209-525-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16522-RAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)