Provider Demographics
NPI:1720793565
Name:THERAPY FOR BLACK WOMEN
Entity type:Organization
Organization Name:THERAPY FOR BLACK WOMEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERISHA
Authorized Official - Middle Name:LACRAE
Authorized Official - Last Name:RUTLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:619-784-4978
Mailing Address - Street 1:5405 BALTIMORE DR APT 31
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5019
Mailing Address - Country:US
Mailing Address - Phone:314-625-6070
Mailing Address - Fax:
Practice Address - Street 1:5353 BALTIMORE DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-4607
Practice Address - Country:US
Practice Address - Phone:619-784-4978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty