Provider Demographics
NPI:1982358115
Name:BLACK, BRITTNEY TASHAWN (CRC, LCMHC, LCAS-A)
Entity type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:TASHAWN
Last Name:BLACK
Suffix:
Gender:F
Credentials:CRC, LCMHC, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 OLD SAINT MARKS CHURCH RD APT 8-1D
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-9440
Mailing Address - Country:US
Mailing Address - Phone:803-629-8645
Mailing Address - Fax:
Practice Address - Street 1:403 E NASH ST # B
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2461
Practice Address - Country:US
Practice Address - Phone:252-477-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24203101YA0400X
NC11789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)