Individual
CARRIE L BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 LEAKE ST STE 106, CARTERSVILLE, GA 30120-3562
(678) 431-2390
Mailing address
884 MISSION RD SW, CARTERSVILLE, GA 30120-7411
(678) 431-2390
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/01/2024
Last updated
06/01/2024
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