Individual
CHRISTINE MARIE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Contact information
Practice address
1 KWAN PLZ, POTOSI, MO 63664-1435
(573) 438-0751
(573) 438-5460
Mailing address
3309 S KINGSHIGHWAY BLVD, SAINT LOUIS, MO 63139-1101
(314) 206-3700
(314) 206-3708
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2008009619
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008009619
STATE LICENSE
MO
Enumeration date
11/10/2010
Last updated
08/12/2024
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