Provider Demographics
NPI:1013219930
Name:BLACK, NAOMI (LPC)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 SYLVAN PL SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-4938
Mailing Address - Country:US
Mailing Address - Phone:404-556-8235
Mailing Address - Fax:404-738-2932
Practice Address - Street 1:610 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-1124
Practice Address - Country:US
Practice Address - Phone:470-206-1262
Practice Address - Fax:404-738-2932
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC-002554101YP2500X
GALPC-006344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003234513AMedicaid