Healthcare Provider Details

I. General information

NPI: 1437084530
Provider Name (Legal Business Name): THE BLACK COLLABORATIVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1212 SYCAMORE ST
CINCINNATI OH
45202-7355
US

IV. Provider business mailing address

5436 WHETSEL AVE
CINCINNATI OH
45227-1730
US

V. Phone/Fax

Practice location:
  • Phone: 215-594-3368
  • Fax:
Mailing address:
  • Phone: 215-594-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NATASHIA L CONNER
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D., M.PHIL, IBCLC
Phone: 215-594-3368