Individual
CRYSTAL BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
2007 WILDWOOD DR, PICAYUNE, MS 39466-2178
(601) 447-4658
Mailing address
144 HICKORY RDG, PICAYUNE, MS 39466-9234
(601) 347-4775
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
23-311832
MS
Other
Enumeration date
12/06/2023
Last updated
12/06/2023
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