Individual
SHARON KIM BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
715 LAKE ST, SUITE 706, OAK PARK, IL 60301-1422
(773) 991-6375
Mailing address
633 CARPENTER AVE, OAK PARK, IL 60304-1104
(773) 991-6375
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180.004472
IL
103T00000X
Psychologist
Primary
071.009658
IL
Other
Enumeration date
01/22/2009
Last updated
11/04/2019
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