Individual
LIZ-EL DOMINIQUE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
124 JOHN ROBERT THOMAS DR, EXTON, PA 19341-2655
(484) 987-9870
Mailing address
937 VAN SANT LN, AMBLER, PA 19002-5054
(215) 421-4164
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
11/03/2023
Last updated
11/03/2023
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