Individual
ADDISON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 TOWNE CENTRE BLVD STE 403, PINEVILLE, NC 28134-8475
(980) 785-1113
(980) 785-1114
Mailing address
814 TYVOLA RD STE 126, CHARLOTTE, NC 28217-3539
(980) 785-1113
(980) 785-1114
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-99326
NC
Other
Enumeration date
09/23/2019
Last updated
09/23/2019
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