| Doctor Name: | SHEILA RUTH BLACK |
| NPI Number: | 1275771859 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | C007565 |
| Business Practice Address: | 10545 Blair Rd Suite 1300 Mint Hill, NC - 282272800 |
| Business Phone Number: | 7043028375 |
| Business Fax Number: | 7043029308 |
| Mailing Address: | Po Box 602148, CHARLOTTE |
| State: | NC |
| Postal Code: | 282602148 |
| Phone Number: | 7043028375 |
| Fax Number: | 7043029308 |
| NPI Enumeration Date: | 02/04/2009 |
| NPI Last Update Date: | 09/17/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | C007565 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |