Individual
KIMBERLY ROCHELLE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC;LCAS-A
Contact information
Practice address
31 E MAIN AVE, TAYLORSVILLE, NC 28681-2540
(704) 872-0234
Mailing address
PO BOX 1545, STATESVILLE, NC 28687-1545
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
24177
NC
101YP2500X
Professional Counselor
Primary
12214
NC
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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