Connie Faye Black

Primary specialty

CounselorTaxonomy code 101Y00000X

License

19265 Issued in FL

Practice address

1830 E Olive Rd
Pensacola, FL 32514-7582

Phone

(850) 473-4461

NPI assigned

Feb 18, 2020

Last updated

Feb 18, 2020By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Olive Baptist Church, Inc

  • Clinical Social Worker
  • Pensacola, FL
  • NPI 1588233787
  NPD

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

{
    "created_epoch": "1581984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581984000000",
    "number": "1659904647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 E OLIVE RD STE 1",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325146153",
            "telephone_number": "850-860-2714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 E OLIVE RD",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325147582",
            "telephone_number": "850-473-4461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CONNIE",
        "middle_name": "FAYE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-02-18",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "FL",
            "license": "19265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cblack@olivebaptist.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1830 E Olive Rd",
            "city": "Pensacola",
            "state": "FL",
            "country_code": "US",
            "postal_code": "325147582",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Moumita Biswas, D.O.
• Gent Bitincka, M.D
• BJ's Wholesale Club Inc.
• Patricia Ann Black-Gould, PHD
• Ashley Black, PMHNP
• Nancy Jean Black, MS
• Taran Lavontaya Black
• Angela Chisum Blackburn, PH.D., A.R.N.P.
• Audrey Rae Blackburn
• Kaitlin Elizabeth Blackburn, DDS

• Counselor in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 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.