Provider Demographics
NPI:1952728933
Name:SANKOFA COMMUNITY COUNSELING, INC
Entity type:Organization
Organization Name:SANKOFA COMMUNITY COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LA TANYA
Authorized Official - Middle Name:ALICIA
Authorized Official - Last Name:TAKLA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, LPCC
Authorized Official - Phone:650-454-6109
Mailing Address - Street 1:PO BOX 3082
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94064-3082
Mailing Address - Country:US
Mailing Address - Phone:650-454-6109
Mailing Address - Fax:
Practice Address - Street 1:3705 HAVEN AVE
Practice Address - Street 2:STE 115
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1011
Practice Address - Country:US
Practice Address - Phone:650-454-6109
Practice Address - Fax:650-231-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49566, LPC 247251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management