Provider Demographics
NPI:1710671649
Name:BLACK, AMOI KYANN (CBHCM)
Entity Type:Individual
Prefix:
First Name:AMOI
Middle Name:KYANN
Last Name:BLACK
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10317 WILLOW OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-4861
Mailing Address - Country:US
Mailing Address - Phone:561-667-5931
Mailing Address - Fax:
Practice Address - Street 1:10317 WILLOW OAKS TRL
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-4861
Practice Address - Country:US
Practice Address - Phone:561-667-5931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator