Organization
BLACK SPACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMERA GITTENS (LMHC)
(929) 445-7277
Entity
Organization
Contact information
Practice address
22722 29TH DRIVE SOUTHEAST SUITE 100, BOTHELL, WA 98021
(929) 445-7277
Mailing address
300 LENORA ST # 1348, SEATTLE, WA 98121-2411
(929) 445-7277
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/22/2025
Last updated
01/22/2025
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