Taiesha Raquel Black

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CDCA.173471 Issued in OH

Practice address

5460 Cleveland Ave
Columbus, OH 43231-4005

Phone

(614) 568-8236

Fax

(614) 392-0275

NPI assigned

Apr 28, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588032000000",
    "number": "1073134292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5460 CLEVELAND AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432314005",
            "telephone_number": "614-568-8236",
            "fax_number": "614-392-0275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5460 CLEVELAND AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432314005",
            "telephone_number": "614-568-8236",
            "fax_number": "614-392-0275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "TAIESHA",
        "middle_name": "RAQUEL",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-28",
        "last_updated": "2020-04-28",
        "certification_date": "2020-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "CDCA.173471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639635899",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige D Black
• Samantha Black, PSY.D.
• Sandra Black, 376J00000X
• Sharon Sue Black, NP-C
• Sylvester Michael Black, MD
• Tracee Black
• Walker Patrick Black
• William Robert Black, PHD
• Kayla Blackburn, MD
• Kimberly Blackburn

• Addiction (Substance Use Disorder) Counselor in Columbus, OH
• Providers in Columbus, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.