Individual
MR. JASON OLIVER BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.P.A., L.C.A.S
Contact information
Practice address
615 SHIPYARD BLVD, WILMINGTON, NC 28412-6431
(910) 343-0145
(910) 341-5779
Mailing address
615 SHIPYARD BLVD, WILMINGTON, NC 28412-6431
(910) 343-0145
(910) 341-5779
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS 3014
NC
103T00000X
Psychologist
4360
NC
Other
Enumeration date
02/08/2012
Last updated
01/27/2016
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