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General NPI Number Information
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NPI Number | 1548810898
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Entity Type | Individual
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Provider Name | RAYMOND BLACK III MA, BS, LMHC, CSAC
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Gender | Male
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/24/2019
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Provider Practice Location Address
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Address Line | 985 DILLINGHAM BLVD STE 100
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City | HONOLULU
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State | HI
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Zip | 96817-5772
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Country | US
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Telephone | 808-834-2823
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Fax |
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Provider Business Mailing Address
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Address Line | 985 DILLINGHAM BLVD STE 100
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City | HONOLULU
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State | HI
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Zip | 96817-5772
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Country | US
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Telephone | 808-392-3605
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1564-10
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License Number State | HI
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MHC-636
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License Number State | HI
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Taxonomy #4
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 2009-835
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License Number State | HI
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