Individual
KHADIJALLAH BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5050 MADISON RD, CINCINNATI, OH 45227-1491
(513) 272-2800
Mailing address
5124 READING RD APT B, CINCINNATI, OH 45237-5327
(513) 562-7782
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C.2406122
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
LICENSURE BOARD
OH
Enumeration date
09/19/2022
Last updated
08/07/2024
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