Provider Demographics
NPI:1962934125
Name:BLACK, JOSHUA ALAN (CAAR)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALAN
Last Name:BLACK
Suffix:
Gender:M
Credentials:CAAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 WESTMOOR CT SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5754
Mailing Address - Country:US
Mailing Address - Phone:360-943-8810
Mailing Address - Fax:360-943-0931
Practice Address - Street 1:2708 WESTMOOR CT SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5754
Practice Address - Country:US
Practice Address - Phone:360-943-8810
Practice Address - Fax:360-943-0931
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60152558101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health