Provider Demographics
NPI:1396837886
Name:BLACK, LA'SHON FELICIA (LCSW, CAP)
Entity Type:Individual
Prefix:MS
First Name:LA'SHON
Middle Name:FELICIA
Last Name:BLACK
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 NW 47 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-2453
Mailing Address - Country:US
Mailing Address - Phone:305-541-5864
Mailing Address - Fax:305-541-8614
Practice Address - Street 1:1492 WEST FLAGLER STREET, SUITE 108
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135
Practice Address - Country:US
Practice Address - Phone:305-541-5864
Practice Address - Fax:305-541-8614
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW47001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV010100OtherLICENSED CLINICAL SOCIAL