Individual
MRS. THERESA L BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, NCC, ACS
Contact information
Practice address
333 IRVING AVE, CAPC FIRST FLOOR, BRIDGETON, NJ 08302-2123
(856) 575-4196
(856) 575-5071
Mailing address
333 IRVING AVE, CAPC FIRST FLOOR, BRIDGETON, NJ 08302-2123
(856) 575-4196
(856) 575-5071
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
37PC00324200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3674509
—
NJ
Enumeration date
05/11/2012
Last updated
03/03/2015
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