Provider Demographics
NPI:1578203873
Name:SAKEENA MIRZA, LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORPORA
Entity Type:Organization
Organization Name:SAKEENA MIRZA, LICENSED CLINICAL SOCIAL WORKER, A PROFESSIONAL CORPORA
Other - Org Name:SUKOON THERAPY AND CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAKEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:424-216-6110
Mailing Address - Street 1:23717 HAWTHORNE BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5982
Mailing Address - Country:US
Mailing Address - Phone:424-216-6110
Mailing Address - Fax:
Practice Address - Street 1:23717 HAWTHORNE BLVD STE 205
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5982
Practice Address - Country:US
Practice Address - Phone:424-216-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty