Provider Demographics
NPI:1568055473
Name:BLACK GEM SOLUTIONS
Entity Type:Organization
Organization Name:BLACK GEM SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:KIP
Authorized Official - Last Name:SENTIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:404-494-7700
Mailing Address - Street 1:1 W COURT SQ STE 750
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2545
Mailing Address - Country:US
Mailing Address - Phone:404-494-7700
Mailing Address - Fax:
Practice Address - Street 1:1 W COURT SQ STE 750
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2545
Practice Address - Country:US
Practice Address - Phone:404-494-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty