Individual
KIMBERLY MARIE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
400 N WASHINGTON ST STE 130B, FARMINGTON, MO 63640-1764
(573) 944-0591
Mailing address
400 N WASHINGTON ST STE 130B, FARMINGTON, MO 63640-1764
(573) 944-0591
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2019005809
MO
Other
Enumeration date
01/26/2021
Last updated
05/04/2023
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