Provider Demographics
NPI:1104901636
Name:DONNA L BLACK LCSW PC
Entity type:Organization
Organization Name:DONNA L BLACK LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW CAC III
Authorized Official - Phone:303-691-3550
Mailing Address - Street 1:1720 S BELLAIRE ST
Mailing Address - Street 2:SUITE 906
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4333
Mailing Address - Country:US
Mailing Address - Phone:303-691-3550
Mailing Address - Fax:303-777-7651
Practice Address - Street 1:1720 S BELLAIRE ST
Practice Address - Street 2:SUITE 906
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4333
Practice Address - Country:US
Practice Address - Phone:303-691-3550
Practice Address - Fax:303-777-7651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3184101YA0400X
CO9899171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty