Individual
JOHANNA CATHERINE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
1501 YARMOUTH AVE, BOULDER, CO 80304-0564
(413) 570-0534
Mailing address
PO BOX 725, LYONS, CO 80540-0725
(617) 971-7844
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
LSW.0009920730
CO
1041C0700X
Clinical Social Worker
Primary
CSW.09924311
CO
Other
Enumeration date
07/21/2015
Last updated
09/13/2018
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