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General NPI Number Information
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NPI Number | 1629844931
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Entity Type | Organization
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Legal Business Name | THE BLACK BRAIN CAMPAIGN
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 6123 VINE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139
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Country | US
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Telephone | 215-531-3377
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Fax |
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Provider Business Mailing Address
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Address Line | 6123 VINE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139
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Country | US
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Telephone | 215-531-3377
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Fax |
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Authorized Official
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Title or Position | CEO/THERAPIST
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Name | MRS. FARIDA BOYER
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Credential |
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Telephone | 267-255-6414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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