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Individual

AMANDA NICHOLE BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2520 UNIVERSITY PARK BLDG D, MT PLEASANT, MI 48858-4464
(989) 775-2529
Mailing address
4731 BROOK LN, MT PLEASANT, MI 48858-2184

Taxonomy

Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary

Other

Enumeration date
10/30/2019
Last updated
10/30/2019
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