Healthcare Provider Details

I. General information

NPI: 1073383220
Provider Name (Legal Business Name): BLACK GIRLS MENTAL HEALTH COLLECTIVE, A FAMILY THERAPY PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W BROADWAY
LONG BEACH CA
90802-4413
US

IV. Provider business mailing address

145 W BROADWAY
LONG BEACH CA
90802-4413
US

V. Phone/Fax

Practice location:
  • Phone: 909-235-6569
  • Fax:
Mailing address:
  • Phone: 909-235-6569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CHYNA HILL
Title or Position: CHIEF OFFICER OF DEVELOPMENT
Credential: PHD, LCSW
Phone: 904-377-9756