| Doctor Name: | MRS. JUDITH ANN BLACK |
| NPI Number: | 1003110198 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC, NCC |
| License Number: | A8388 |
| Business Practice Address: | 7230 Heritage Village Plz Gainesville, VA - 201553053 |
| Business Phone Number: | 9106897100 |
| Business Fax Number: | |
| Mailing Address: | 11651 Iron Brigade Unit Ave, BRISTOW |
| State: | VA |
| Postal Code: | 201361345 |
| Phone Number: | 9106897100 |
| Fax Number: | |
| NPI Enumeration Date: | 01/04/2011 |
| NPI Last Update Date: | 02/25/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | A8388 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |