| Doctor Name: | STEPHANIE LAMAR BLACK |
| NPI Number: | 1104053016 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 93199 |
| Business Practice Address: | 1035 Cheraw Street Bennettsville, SC - 29512 |
| Business Phone Number: | 8434540442 |
| Business Fax Number: | |
| Mailing Address: | P.o. Box 918, BENNETTSVILLE |
| State: | SC |
| Postal Code: | 29512 |
| Phone Number: | 8434540841 |
| Fax Number: | 8434540635 |
| NPI Enumeration Date: | 06/18/2009 |
| NPI Last Update Date: | 09/30/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | 93199 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |