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General NPI Number Information
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NPI Number | 1942951405
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Entity Type | Organization
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Legal Business Name | BLACK THERAPIST & COMPANY, LLC
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Dates
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Enumeration Date | 01/15/2022
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Last Update Date | 01/15/2022
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Provider Practice Location Address
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Address Line | 10700 SW BEAVERTON HILLSIDALE HWY BLDG #3, SUITE # 560
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City | BEAVERTON
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State | OR
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Zip | 97005
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Country | US
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Telephone | 503-628-9452
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Fax | 503-356-3087
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Provider Business Mailing Address
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Address Line | 6107 SW MURRAY BLVD # 310
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City | BEAVERTON
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State | OR
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Zip | 97008-4421
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Country | US
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Telephone | 503-628-9452
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Fax | 503-356-3087
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Authorized Official
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Title or Position | OWNER
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Name | ROSEMARIE HEMMINGS
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Credential | PH.D., LCSW
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Telephone | 503-628-9452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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