Organization
MOURNING GLORY CLUB INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEKSEI ARCHER (FOUNDER)
(646) 436-5976
Entity
Organization
Contact information
Practice address
7 FLEET ST APT 108, MARINA DEL REY, CA 90292-5731
(646) 436-5976
Mailing address
7 FLEET ST APT 108, MARINA DEL REY, CA 90292-5731
(646) 436-5976
Taxonomy
Speciality
Code
Description
License number
State
225XM0800X
Mental Health Occupational Therapist
Primary
—
—
Other
Enumeration date
02/11/2025
Last updated
02/11/2025
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