Provider Demographics
NPI:1093860579
Name:BLACK, TONYA (LPCC)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 HYDE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2133
Mailing Address - Country:US
Mailing Address - Phone:216-408-1564
Mailing Address - Fax:
Practice Address - Street 1:540 E 105TH ST STE 205H
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-4310
Practice Address - Country:US
Practice Address - Phone:216-352-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC7592101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor