Provider Demographics
NPI:1366108748
Name:THE BLACK KNIGHT LLC
Entity type:Organization
Organization Name:THE BLACK KNIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAKA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PHAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:CSW-R
Authorized Official - Phone:917-846-3060
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-0114
Mailing Address - Country:US
Mailing Address - Phone:917-846-3060
Mailing Address - Fax:718-732-2995
Practice Address - Street 1:32 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4421
Practice Address - Country:US
Practice Address - Phone:917-846-3060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-10
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty