Kaneisha Black, PSY.D

Primary specialty

School PsychologistTaxonomy code 103TS0200X

Practice address

710 Wildlife LN
Columbia, SC 29209-3464

Phone

(704) 763-7479

NPI assigned

May 15, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1609625201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 WILDLIFE LN",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292093464",
            "telephone_number": "704-763-7479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 WILDLIFE LN",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292093464",
            "telephone_number": "704-763-7479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KANEISHA",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, School",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kate Bjorgo
• Debra Ann Bjork, D.O.
• Alexa Cox Black, DMD
• Jazmine Black
• Jonathan Black, MD
• Thomas Black, M.D.
• Melanie Diane Blackburn, M.D.
• Benjamin B Blackmon Jr., MD
• Courtney Blackmon, RD LD
• Charlotte M. Blackstone

• School Psychologist in Columbia, SC
• Providers in Columbia, SC by specialty
• School Psychologist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2024; 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.