Individual
ELIZABETH BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
107 WOODLAND CT STE B, MICHIGAN CITY, IN 46360-7393
(219) 229-7188
Mailing address
141 KINGSBURY AVE, LA PORTE, IN 46350-5260
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
33010846A
IN
1041C0700X
Clinical Social Worker
Primary
34011206A
IN
Other
Enumeration date
07/25/2023
Last updated
09/24/2024
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