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Individual
MICHAEL BLACK
Active
Individual
MICHAEL BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CACIII
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACC-7098
CO
1041C0700X
Clinical Social Worker
CSW-1229
CO
Other
Enumeration date
03/08/2011
Last updated
03/08/2011
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