Healthcare Provider Details

I. General information

NPI: 1689605412
Provider Name (Legal Business Name): RHONIE BLACK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RHONIE BLACK-TYSON

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S MAUMEE ST
TECUMSEH MI
49286-2033
US

IV. Provider business mailing address

2200 JEFFERSON AVE 5TH FL
TOLEDO OH
43604-7101
US

V. Phone/Fax

Practice location:
  • Phone: 517-423-6889
  • Fax: 517-423-6890
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1502411
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number002382
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: