Provider Demographics
NPI:1700466869
Name:ANXIOUS BLACK GIRLS
Entity Type:Organization
Organization Name:ANXIOUS BLACK GIRLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DESERAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:718-825-1996
Mailing Address - Street 1:7154 SPORTSMANS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5456
Mailing Address - Country:US
Mailing Address - Phone:718-825-1996
Mailing Address - Fax:
Practice Address - Street 1:7154 SPORTSMANS DR
Practice Address - Street 2:
Practice Address - City:NORTH LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33068-5456
Practice Address - Country:US
Practice Address - Phone:718-825-1996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty