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General NPI Number Information
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NPI Number | 1841005238
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Entity Type | Organization
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Legal Business Name | BLACK COTTON THERAPY SERVICES LLC
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 06/22/2025
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Provider Practice Location Address
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Address Line | 5000 THAYER CTR STE C
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City | OAKLAND
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State | MD
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Zip | 21550-1139
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Country | US
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Telephone | 509-768-2249
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Fax |
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Provider Business Mailing Address
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Address Line | 741 PIEDMONT AVE NE STE 200
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City | ATLANTA
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State | GA
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Zip | 30308-1420
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Country | US
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Telephone | 470-431-5770
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | TANISHA COLEMAN
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Credential |
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Telephone | 404-987-8369
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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