Individual
DONNA BLACK DOG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
603 1/2 COURT AVE., POPLAR, MT 59255
(406) 768-5364
(406) 768-5202
Mailing address
603 1/2 COURT AVENUE, POPLAR, MT 59255
(406) 768-5364
(406) 768-5202
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LAC-LAC-LIC-1393
MT
Other
Enumeration date
01/30/2017
Last updated
01/30/2017
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