Provider Demographics
NPI:1710563721
Name:GIRL GENIUS LABS LLC
Entity Type:Organization
Organization Name:GIRL GENIUS LABS LLC
Other - Org Name:ELAINE HICKS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:LELANDA
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-675-1086
Mailing Address - Street 1:91-1265 KAMAAHA AVE APT 507
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4917
Mailing Address - Country:US
Mailing Address - Phone:808-675-1086
Mailing Address - Fax:
Practice Address - Street 1:91-1265 KAMAAHA AVE APT 507
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-4917
Practice Address - Country:US
Practice Address - Phone:808-675-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-20
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI15107328Medicaid