Provider Demographics
NPI:1063294528
Name:GROWTH AND SELF LOVE LLC
Entity type:Organization
Organization Name:GROWTH AND SELF LOVE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIKRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:CIRIKOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-290-8507
Mailing Address - Street 1:74 BEACON VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-3703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:74 BEACON VIEW DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-3703
Practice Address - Country:US
Practice Address - Phone:203-290-8507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health