Active NPI
Floanna Black, MA, TLLP
- Other Technician
- Dearborn, MI
National Provider Identifier
1447600549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 19853 Outer Dr Ste 110
Dearborn, MI 48124-2044 - Phone
- (313) 406-5056
- Fax
- (313) 908-9181
- NPI assigned
- Jun 20, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301017194 | MI | |
| Other Technician | 247200000X | Primary |
Addresses
Primary practice location
19853 Outer Dr Ste 110
Dearborn, MI 48124-2044
Mailing address
10601 Mount Vernon St Apt 202
Taylor, MI 48180-6910
Phone (313) 926-3567
Other practice location 1
3200 Greenfield Rd Ste 300
Dearborn, MI 48120-1800
Phone (313) 926-3567
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301017194 | MI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rise Therapeutic Counseling LLC | Clinical | Current | Accepting new patients |
| Rise Therapeutic Counseling | Clinical | Current | Accepting new patients |
Locations
3200 Greenfield Rd
Ste 300
Dearborn, MI 48120
Phone (313) 318-8208
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1466380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623715200000",
"number": "1447600549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10601 MOUNT VERNON ST APT 202",
"city": "TAYLOR",
"state": "MI",
"postal_code": "481806910",
"telephone_number": "313-926-3567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19853 OUTER DR STE 110",
"city": "DEARBORN",
"state": "MI",
"postal_code": "481242044",
"telephone_number": "313-406-5056",
"fax_number": "313-908-9181"
}
],
"practiceLocations": [
{
"address_1": "3200 Greenfield Rd Ste 300",
"address_purpose": "LOCATION",
"city": "Dearborn",
"state": "MI",
"postal_code": "481201800",
"country_code": "US",
"telephone_number": "313-926-3567",
"fax_number": "734-544-5100",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLACK",
"first_name": "FLOANNA",
"name_prefix": "Mrs.",
"credential": "MA, TLLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-20",
"last_updated": "2021-06-15",
"certification_date": "2021-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301017194",
"primary": false
},
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dearborn, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.