Individual
DR. JUDITH ANN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, LPC, LCMHC, NCC
Contact information
Practice address
207 FAIRMONT AVE, FAIRMONT, WV 26554-2710
(681) 404-6869
Mailing address
12 WOODCLIFF DR, FAIRMONT, WV 26554-1257
(910) 689-7100
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
0701005401
VA
101YP2500X
Professional Counselor
Primary
2278
WV
101YP2500X
Professional Counselor
275728
NC
101YP2500X
Professional Counselor
8388
NC
101YP2500X
Professional Counselor
A8388
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
WVTPID009357
—
WV
Enumeration date
01/04/2011
Last updated
03/16/2023
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