Healthcare Provider Details

I. General information

NPI: 1174065403
Provider Name (Legal Business Name): RASHIDA BLACK LCSW, ICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2016
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2424 VISTA WAY STE 315
OCEANSIDE CA
92054-6178
US

IV. Provider business mailing address

2424 VISTA WAY STE 315
OCEANSIDE CA
92054-6178
US

V. Phone/Fax

Practice location:
  • Phone: 760-576-4160
  • Fax:
Mailing address:
  • Phone: 760-576-4160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101344
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04878
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: