Individual
CORRIN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3443 LILLY RD NE, OLYMPIA, WA 98506-3091
(360) 456-2237
Mailing address
3804 12TH AVE SE APT 201, LACEY, WA 98503-2006
(509) 990-4262
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
WA
Other
Enumeration date
03/29/2021
Last updated
03/29/2021
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