| Doctor Name: | MRS. SOPHIA H. BLACK |
| NPI Number: | 1205032802 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC, NCC |
| License Number: | 3734 |
| Business Practice Address: | 110 Amersham Ct Kernersville, NC - 272846835 |
| Business Phone Number: | 3367881785 |
| Business Fax Number: | |
| Mailing Address: | 110 Amersham Ct, KERNERSVILLE |
| State: | NC |
| Postal Code: | 272846835 |
| Phone Number: | 3367881785 |
| Fax Number: | |
| NPI Enumeration Date: | 06/21/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 3734 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |