| Doctor Name: | RANDALL BLACK |
| NPI Number: | 1043322068 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW, LSOTP |
| License Number: | S23276 |
| Business Practice Address: | 1610 Calico Canyon Ln Pearland, TX - 775815574 |
| Business Phone Number: | 2814507724 |
| Business Fax Number: | 8666426202 |
| Mailing Address: | 1610 Calico Canyon Ln, PEARLAND |
| State: | TX |
| Postal Code: | 775815574 |
| Phone Number: | 2814507724 |
| Fax Number: | 8666426202 |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 01/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | S23276 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |