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General NPI Number Information
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NPI Number | 1487020285
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Entity Type | Organization
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Legal Business Name | SANKOFA WEST COUNSELING CENTER
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Dates
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Enumeration Date | 08/15/2015
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Last Update Date | 08/15/2015
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Provider Practice Location Address
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Address Line | 826 E CHARLESTON BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89104-1512
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Country | US
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Telephone | 702-622-6516
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Fax | 702-586-7530
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Provider Business Mailing Address
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Address Line | 1191 WARM CANYON WAY
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City | LAS VEGAS
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State | NV
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Zip | 89123-3603
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Country | US
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Telephone | 702-622-6516
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Fax | 702-586-7530
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Authorized Official
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Title or Position | CEO
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Name | MR. LESHAWUN RASHAAD PORTER SR.
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Credential |
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Telephone | 702-622-6516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | NV20151486602
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License Number State | NV
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