Individual
STACY ANNE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 OLD HWY 99, MT. VERNON, WA 98273
(360) 398-5444
Mailing address
18092 MONTBORNE RD, MOUNT VERNON, WA 98274-8154
(618) 979-0626
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MG60835827
WA
Other
Enumeration date
03/21/2018
Last updated
03/21/2018
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