Black Space LLC
NPI #1427860022 in Bothell, Washington
Provider Information
- NPI Number
- 1427860022
- Entity Type
- Organization
- Organization Name
- Black Space LLC
- Primary Specialty
- Counselor - Mental Health
- Enumeration Date
- Jan 22, 2025
- Last Updated
- Jan 22, 2025
Practice Location
- Address
- 22722 29TH DRIVE SOUTHEAST SUITE 100
- City
- Bothell
- State
- Washington
- ZIP Code
- 98021
- Phone
- (929) 445-7277
Authorized Official
- Name
- TAMERA GITTENS
- Title
- LMHC
- Phone
- (929) 445-7277
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Mental Health — Mental Health |
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