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Individual
MR. WILLIAM JESSE BLACK
Active
Individual
MR. WILLIAM JESSE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW, LADC, BCD
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
300555
MN
1041C0700X
Clinical Social Worker
4476
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972716314
—
MN
Enumeration date
05/08/2007
Last updated
06/21/2021
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