Provider Demographics
NPI:1821758046
Name:IT'S COMPLICATED CONSULTATION SERVICES INC.
Entity Type:Organization
Organization Name:IT'S COMPLICATED CONSULTATION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYSCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NNEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-829-9561
Mailing Address - Street 1:1271 WASHINGTON AVE # 727
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3646
Mailing Address - Country:US
Mailing Address - Phone:510-829-9561
Mailing Address - Fax:
Practice Address - Street 1:3220 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2726
Practice Address - Country:US
Practice Address - Phone:510-829-9561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health