Doctor Name: | MISS DEBRA BLACK |
NPI Number: | 1013149269 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 1769 E Country Ln Gilbert, AZ - 852986166 |
Business Phone Number: | 4803101245 |
Business Fax Number: | 4808954488 |
Mailing Address: | 1769 E Country Ln, GILBERT |
State: | AZ |
Postal Code: | 852986166 |
Phone Number: | 4803101245 |
Fax Number: | 4808954488 |
NPI Enumeration Date: | 08/20/2009 |
NPI Last Update Date: | 08/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |