Individual
LEORA ELIZABETH BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
525 HERCULES DR, SUITE 1A, COLCHESTER, VT 05446-5993
(802) 264-5333
(802) 264-5338
Mailing address
231 COUNTRY MDWS, COLCHESTER, VT 05446-7072
(802) 264-5333
(802) 264-5338
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
068-0000067
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1006789
—
VT
Enumeration date
11/09/2006
Last updated
12/13/2023
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