Provider Demographics
NPI:1689371981
Name:BLACK COUCH THERAPY LLC
Entity Type:Organization
Organization Name:BLACK COUCH THERAPY LLC
Other - Org Name:BLACK COUCH THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TESIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-272-6330
Mailing Address - Street 1:739 THIMBLE SHOALS BLVD BLDG 704
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3562
Mailing Address - Country:US
Mailing Address - Phone:757-272-6330
Mailing Address - Fax:
Practice Address - Street 1:739 THIMBLE SHOALS BLVD BLDG 704
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3562
Practice Address - Country:US
Practice Address - Phone:757-272-6330
Practice Address - Fax:757-765-7709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty