Individual
MATTHEW A. BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
601 CUMBERLAND ST, CHATTANOOGA, TN 37404-1922
(423) 266-6751
(423) 763-4662
Mailing address
1028 E 3RD ST, CHATTANOOGA, TN 37403-2107
(423) 266-6751
(423) 763-4650
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC1809
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5441670
TENNCARE
TN
Enumeration date
01/24/2007
Last updated
04/23/2008
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