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Individual

MRS. ALEXA MARIE BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW, PMH-C

Contact information

Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-5529
Mailing address
915 STONEHENGE DR, NORTH SALT LAKE, UT 84054-6001
(801) 440-0215

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
1041C0700X
Clinical Social Worker
Primary
11599470-3501
UT

Other

Enumeration date
05/22/2019
Last updated
04/20/2024
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