Provider Demographics
NPI:1578291522
Name:THE PINK MOON HEALING COLLECTIVE, A LICENSED SOCIAL WORKER CORPORATION
Entity Type:Organization
Organization Name:THE PINK MOON HEALING COLLECTIVE, A LICENSED SOCIAL WORKER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUBRI
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-703-6234
Mailing Address - Street 1:341 N RENO ST # N4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4507
Mailing Address - Country:US
Mailing Address - Phone:213-703-6234
Mailing Address - Fax:
Practice Address - Street 1:341 N RENO ST # N4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4507
Practice Address - Country:US
Practice Address - Phone:213-703-6234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty