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General NPI Number Information
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NPI Number | 1366108748
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Entity Type | Organization
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Legal Business Name | THE BLACK KNIGHT LLC
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 32 COURT ST
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City | BROOKLYN
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State | NY
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Zip | 11201-4421
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Country | US
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Telephone | 917-846-3060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 114
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City | BRONX
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State | NY
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Zip | 10456-0114
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Country | US
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Telephone | 917-846-3060
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Fax | 718-732-2995
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Authorized Official
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Title or Position | OWNER
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Name | CHAKA C PHAIRE
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Credential | CSW-R
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Telephone | 917-846-3060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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