Individual
JESSICA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
730 MAIN ST # 230, NORTH MYRTLE BEACH, SC 29582-3030
(813) 763-5469
(813) 441-8362
Mailing address
1927 KATE LN, MYRTLE BEACH, SC 29575-5319
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
Primary
RBT-26-535835
SC
Other
Enumeration date
02/03/2026
Last updated
05/20/2026
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