Provider Demographics
NPI:1871939900
Name:BLACK, DENNIS W (CADC)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:W
Last Name:BLACK
Suffix:
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 CALLE DE LA PLATA
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89441-8520
Mailing Address - Country:US
Mailing Address - Phone:775-348-8811
Mailing Address - Fax:775-348-8830
Practice Address - Street 1:1027 N SIERRA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-3722
Practice Address - Country:US
Practice Address - Phone:775-329-9830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor