Individual
JOHNATHAN SHANE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7120 AIRPORT BLVD, MOBILE, AL 36608-4502
(251) 345-3303
Mailing address
7120 AIRPORT BLVD, MOBILE, AL 36608-4502
(251) 345-3303
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3106
AL
Other
Enumeration date
11/02/2017
Last updated
11/02/2017
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