| Doctor Name: | LAURA BLACK |
| NPI Number: | 1043695927 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 1338 |
| Business Practice Address: | 607 Hammond Plz Hopkinsville, KY - 422404971 |
| Business Phone Number: | 2708819551 |
| Business Fax Number: | 2708855871 |
| Mailing Address: | Po Box 614, HOPKINSVILLE |
| State: | KY |
| Postal Code: | 422410614 |
| Phone Number: | 2708862205 |
| Fax Number: | 2708860392 |
| NPI Enumeration Date: | 07/21/2015 |
| NPI Last Update Date: | 07/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 1338 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |