Provider Demographics
NPI:1043851868
Name:J. FRANCIS BLACK LLC
Entity Type:Organization
Organization Name:J. FRANCIS BLACK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JERRILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:202-643-1501
Mailing Address - Street 1:6645 GEORGIA AVE NW APT 201
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2539
Mailing Address - Country:US
Mailing Address - Phone:817-205-1283
Mailing Address - Fax:
Practice Address - Street 1:3000 CONNECTICUT AVE NW STE 137
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2549
Practice Address - Country:US
Practice Address - Phone:202-643-1501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health