Healthcare Provider Details

I. General information

NPI: 1457818437
Provider Name (Legal Business Name): GIRLS GOSSIP AND WOMEN NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 04/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9791 ARROW RTE
RANCHO CUCAMONGA CA
91730-3602
US

IV. Provider business mailing address

12223 HIGHLAND AVE # 106-580
RANCHO CUCAMONGA CA
91739-2574
US

V. Phone/Fax

Practice location:
  • Phone: 909-767-3593
  • Fax:
Mailing address:
  • Phone: 909-767-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SANIYYAH SHALEECE MAYO
Title or Position: CEO/FOUNDER
Credential: LMFT
Phone: 909-767-3593