Individual
JESSICA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1927 KATE LN, MYRTLE BEACH, SC 29575-5319
(843) 283-1688
Mailing address
1927 KATE LN, MYRTLE BEACH, SC 29575-5319
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/03/2026
Last updated
02/03/2026
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