Provider Demographics
NPI:1710450242
Name:GROW AND DEVELOP WITH INESSA LLC
Entity Type:Organization
Organization Name:GROW AND DEVELOP WITH INESSA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER ABA THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:INESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKHCHAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:347-741-5968
Mailing Address - Street 1:15034 76TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3141
Mailing Address - Country:US
Mailing Address - Phone:347-741-5968
Mailing Address - Fax:
Practice Address - Street 1:15034 76TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3141
Practice Address - Country:US
Practice Address - Phone:347-741-5968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty