Provider Demographics
NPI:1285409359
Name:PRIVATE PRACTICE FOR BLACK GIRLS, LLC
Entity type:Organization
Organization Name:PRIVATE PRACTICE FOR BLACK GIRLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABBI
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LPC-S, LMSW
Authorized Official - Phone:409-225-6044
Mailing Address - Street 1:18806 CENTERRA SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-7598
Mailing Address - Country:US
Mailing Address - Phone:409-225-6044
Mailing Address - Fax:
Practice Address - Street 1:14405 WALTERS RD STE 1016
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1493
Practice Address - Country:US
Practice Address - Phone:832-559-7520
Practice Address - Fax:832-559-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty