Provider Demographics
NPI:1245948272
Name:MELANIN MOMMY THERAPY
Entity type:Organization
Organization Name:MELANIN MOMMY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:610-675-3733
Mailing Address - Street 1:4211 WOODLAND AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3929
Mailing Address - Country:US
Mailing Address - Phone:717-491-3666
Mailing Address - Fax:
Practice Address - Street 1:4211 WOODLAND AVE APT 305
Practice Address - Street 2:
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-3929
Practice Address - Country:US
Practice Address - Phone:717-491-3666
Practice Address - Fax:267-433-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty