CAROLLYN BLACK (NPI# 1689216293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689216293 |
| Entity Type | Individual |
| Full Name | CAROLLYN BLACK |
| Practice Address |
4892 N 19th St Milwaukee WI 53209-5757 |
| Practice Telephone | 4145953630 |
| Mailing Telephone | 4145953630 |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2019-10-15 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
18939-130 | WI | Behavioral Health & Social Service Providers |
| Street Address |
4892 N 19TH ST |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53209-5757 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780238253 | Niajcia Brookshire | Counselor | 3900 W Brown Deer Rd Suite 200, Brown Deer, WI 53209 | 2019-08-01 |
| 1740751015 | Mary Fuller | Home Health Aide | 3043 N 29th St., Milwaukee, WI 53209 | 2018-12-16 |
| 1154869410 | Jacksonscott2 | Skilled Nursing Facility | 4573 N. 22nd Street, Milwaukee, WI 53209 | 2017-02-07 |
| 1669910469 | Dimera House | In Home Supportive Care | 4002 W Fairount Ave, Milwaukee, WI 53209 | 2017-02-01 |
| 1891248340 | Amy L May | Nurse Practitioner | 3303 W Good Hope Rd, Milwaukee, WI 53209 | 2016-08-02 |
| 1871980193 | Alan R Rosenthal | Pharmacist | 6930 N Beech Tree Dr, Milwaukee, WI 53209 | 2015-04-24 |
| 1104212380 | Reema Shah | Student in an Organized Health Care Education/Training Program | 2400 W. Villard Ave, Milwaukee, WI 53209 | 2015-04-14 |
| 1336534403 | Robert Michael Kitsis | Family Medicine | 9252 N Green Bay Rd Fl 2, Brown Deer, WI 53209 | 2015-04-05 |
| 1962891994 | Kls Community Outreach Teen Center Consulting and Management L.L.C. | Public Health or Welfare | 8330 North Teutonia Ave Suite 103, Brown Deer, WI 53209 | 2015-01-14 |
| 1548659634 | Kls Community Outreach Teen Center Consulting and Management L.L.C. | Early Intervention Provider Agency | 8330 North Teutonia Avenue Suite 103, Brown Deer, WI 53209 | 2015-01-13 |
| Find all providers in zip 53209 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649879982 | Veronicia S Green | Counselor | 2821 N Vel R Phillips Ave Ste 131, Milwaukee, WI 53212-2370 | 2020-10-19 |
| 1932733193 | 1 Step Away Divine Counseling Service LLC | Counselor | 6815 W Capitol Dr Ste 308, Milwaukee, WI 53216-2056 | 2020-02-26 |
| 1861046146 | Lisa Marie Ortiz | Counselor | 3336 S 76th St, Milwaukee, WI 53219-3805 | 2019-07-25 |
| 1891359576 | Kenneth Ginlack Sr Consulting Services LLC | Counselor | 3927 S Howell Ave Ste 102, Milwaukee, WI 53207-4421 | 2019-04-27 |
| 1649733189 | Stacey King | Counselor | Rivershore Comprehensive Treatment Facility, 3703 N Richards St, Milwaukee Wi, Milwaukee, WI 53212 | 2019-04-11 |
| 1821561168 | Lydia Ann Mendez | Counselor | 3703 N Richards St, Milwaukee, WI 53212 | 2019-01-09 |
| 1851863302 | Glen Victor Fleming | Counselor | 2821 North 4th Street Suite 210, Milwaukee, WI 53212 | 2018-12-21 |
| 1992280218 | Tanya Lynn Peters | Counselor | 9224 W Burleigh St, Milwaukee, WI 53222-3503 | 2018-10-02 |
| 1467948844 | Alexcis Coleman | Counselor | 6815 W Capitol Dr Ste 217, Milwaukee, WI 53216 | 2018-07-09 |
| 1639664923 | Krystalyn Goode | Counselor | 2625 N Weil Street, Milwaukee, WI 53212 | 2018-06-28 |
| Find all providers in MILWAUKEE | ||||
Please comment or provide details below to improve the information on CAROLLYN BLACK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.