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Organization
BONITA HEALTH CLINIC
Active
Organization
BONITA HEALTH CLINIC
Active
Parent organization
RAJAEE BLACK LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
RAJAEE BLACK LLC
Authorized official
MR. RAJAEE BLACK CRNA (PRESIDENT)
(215) 500-7580
Entity
Organization
Contact information
Practice address
6124 LANDOVER RD, CHEVERLY, MD 20785-1016
(215) 500-7580
Mailing address
2104 PINEY BRANCH CIR APT 509, HANOVER, MD 21076-1838
(215) 500-7580
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
10/09/2019
Last updated
10/09/2019
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