Healthcare Provider Details

I. General information

NPI: 1629901277
Provider Name (Legal Business Name): ELENA BLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 S ST NW STE 6
WASHINGTON DC
20009-6107
US

IV. Provider business mailing address

2200 19TH ST NW APT 802
WASHINGTON DC
20009-1425
US

V. Phone/Fax

Practice location:
  • Phone: 202-234-7738
  • Fax:
Mailing address:
  • Phone: 202-604-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: