Provider Demographics
NPI:1639741283
Name:BLACK, DAMEKA LATRICE
Entity Type:Individual
Prefix:MS
First Name:DAMEKA
Middle Name:LATRICE
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 1:2312 GOOD HOPE RD SE APT 20
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4121
Mailing Address - Country:US
Mailing Address - Phone:757-944-3698
Mailing Address - Fax:
Practice Address - Street 1:890 SOUTHERN AVE SE APT 310
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3438
Practice Address - Country:US
Practice Address - Phone:757-944-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X
DCLG50082862104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant