Provider Demographics
NPI:1548810898
Name:BLACK, RAYMOND III (MA, BS, LMHC, CSAC)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:BLACK
Suffix:III
Gender:M
Credentials:MA, BS, LMHC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 DILLINGHAM BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-5772
Mailing Address - Country:US
Mailing Address - Phone:808-392-3605
Mailing Address - Fax:
Practice Address - Street 1:985 DILLINGHAM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-5772
Practice Address - Country:US
Practice Address - Phone:808-834-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI101Y00000X
HI1564-10101YA0400X
HIMHC-636101YM0800X
HI2009-835101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health