Provider Demographics
NPI:1407624281
Name:BLACK, TENISHA
Entity Type:Individual
Prefix:
First Name:TENISHA
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 HAYES ST NE APT 221
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5564
Mailing Address - Country:US
Mailing Address - Phone:202-758-8011
Mailing Address - Fax:
Practice Address - Street 1:5201 HAYES ST NE APT 221
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5564
Practice Address - Country:US
Practice Address - Phone:202-758-8011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator