| Doctor Name: | SANDRA F BLACK |
| NPI Number: | 1174765481 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSAC |
| License Number: | |
| Business Practice Address: | 100 Old Sturgis Rd Ackerman, MS - 397356600 |
| Business Phone Number: | 6622856225 |
| Business Fax Number: | 6622856226 |
| Mailing Address: | 302 N Jackson St, P O Box 1188 STARKVILLE |
| State: | MS |
| Postal Code: | 397592504 |
| Phone Number: | 6623239261 |
| Fax Number: | 6623249647 |
| NPI Enumeration Date: | 04/01/2009 |
| NPI Last Update Date: | 06/07/2010 |
| 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: | |