Healthcare Provider Details

I. General information

NPI: 1598691537
Provider Name (Legal Business Name): ELIJAH TAYLOR BLACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 HALF ST SE APT 201
WASHINGTON DC
20003-4295
US

IV. Provider business mailing address

1201 HALF ST SE APT 201
WASHINGTON DC
20003-4295
US

V. Phone/Fax

Practice location:
  • Phone: 202-492-4576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200004761
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: