Provider Demographics
NPI:1003315839
Name:ANXIETY GAMING INC
Entity Type:Organization
Organization Name:ANXIETY GAMING INC
Other - Org Name:RISE ABOVE THE DISORDER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-732-7785
Mailing Address - Street 1:5150 CANDLEWOOD STREET
Mailing Address - Street 2:6E
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1925
Mailing Address - Country:US
Mailing Address - Phone:562-303-3694
Mailing Address - Fax:
Practice Address - Street 1:5150 CANDLEWOOD STREET
Practice Address - Street 2:6E
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1925
Practice Address - Country:US
Practice Address - Phone:562-303-3694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health