Healthcare Provider Details

I. General information

NPI: 1104901636
Provider Name (Legal Business Name): DONNA L BLACK LCSW PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S BELLAIRE ST SUITE 906
DENVER CO
80222-4333
US

IV. Provider business mailing address

1720 S BELLAIRE ST SUITE 906
DENVER CO
80222-4333
US

V. Phone/Fax

Practice location:
  • Phone: 303-691-3550
  • Fax: 303-777-7651
Mailing address:
  • Phone: 303-691-3550
  • Fax: 303-777-7651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3184
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989917
License Number StateCO

VIII. Authorized Official

Name: DONNA L BLACK
Title or Position: PRESIDENT
Credential: LCSW CAC III
Phone: 303-691-3550