Provider Demographics
NPI:1851086706
Name:BREATHE ANGER MANAGEMENT
Entity Type:Organization
Organization Name:BREATHE ANGER MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AQUANETTA
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:BANKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-378-0080
Mailing Address - Street 1:815 N LA BREA AVE # 414
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-2205
Mailing Address - Country:US
Mailing Address - Phone:818-378-0080
Mailing Address - Fax:
Practice Address - Street 1:904 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-2226
Practice Address - Country:US
Practice Address - Phone:818-378-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty