Provider Demographics
NPI:1487020285
Name:SANKOFA WEST COUNSELING CENTER
Entity Type:Organization
Organization Name:SANKOFA WEST COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LESHAWUN
Authorized Official - Middle Name:RASHAAD
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:702-622-6516
Mailing Address - Street 1:1191 WARM CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-3603
Mailing Address - Country:US
Mailing Address - Phone:702-622-6516
Mailing Address - Fax:702-586-7530
Practice Address - Street 1:826 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-1512
Practice Address - Country:US
Practice Address - Phone:702-622-6516
Practice Address - Fax:702-586-7530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-15
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151486602251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health