Provider Demographics
NPI:1689400426
Name:BLACK, DE'JA
Entity type:Individual
Prefix:
First Name:DE'JA
Middle Name:
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 1:5210 MISTY OAKS DR APT 1512
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-2423
Mailing Address - Country:US
Mailing Address - Phone:843-468-4032
Mailing Address - Fax:
Practice Address - Street 1:5210 MISTY OAKS DR APT 1512
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-2423
Practice Address - Country:US
Practice Address - Phone:843-468-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula