Healthcare Provider Details

I. General information

NPI: 1083531503
Provider Name (Legal Business Name): IN HER LEGACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N BRAND BLVD STE 890
GLENDALE CA
91203-3398
US

IV. Provider business mailing address

PO BOX 1256
NEWARK CA
94560-6256
US

V. Phone/Fax

Practice location:
  • Phone: 408-883-0292
  • Fax:
Mailing address:
  • Phone: 408-883-0292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MONIQUE WRIGHT-GORY
Title or Position: FOUNDER
Credential:
Phone: 408-883-0292