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NPI Code Detail

MEDICARE: NIKITA BLACK MSW

MEDICARE: NIKITA BLACK MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1568838274
Entity Type Code : Individual
Provider Name (Legal Business Name) : NIKITA BLACK MSW
Provider Business Mailing Address
First Line : 3018 OLD MINDEN RD STE 1117
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71112-2497
Country : US
Telephone Number : 318-746-1935
Fax Number : 318-746-2514
Provider Business Practice Location Address
First Line : 3018 OLD MINDEN RD STE 1117
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71112-2497
Country : US
Telephone Number : 318-746-1935
Fax Number : 318-746-2514
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2015
Last Update Date : 08/17/2015

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