Healthcare Provider Details

I. General information

NPI: 1316765936
Provider Name (Legal Business Name): NYUNDERGROUND INITIATIVE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 ERSKINE ST APT 537
BROOKLYN NY
11239-2899
US

IV. Provider business mailing address

911 ERSKINE ST APT 537
BROOKLYN NY
11239-2899
US

V. Phone/Fax

Practice location:
  • Phone: 917-930-0575
  • Fax:
Mailing address:
  • Phone: 917-930-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. EBONY NICHOLE HOOD
Title or Position: CEO
Credential: MHFA, LIFE COACH
Phone: 917-930-0575