Individual
SHAPHAUN TAMARA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CSAC
Contact information
Practice address
1409 EAST BLVD, SUITE 201, CHARLOTTE, NC 28203-5817
(980) 225-7899
Mailing address
PO BOX 681282, CHARLOTTE, NC 28216-0023
(704) 965-8119
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
2726
NC
Other
Enumeration date
09/02/2014
Last updated
09/02/2014
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