Individual
PHYLLIS REGINA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CDP
Contact information
Practice address
325 9TH AVE # 359797, SEATTLE, WA 98104-2420
(206) 744-9612
(206) 744-9920
Mailing address
325 9TH AVE # 359797, SEATTLE, WA 98104-2420
(206) 744-9612
(206) 744-9920
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP60097360
WA
Other
Enumeration date
01/07/2010
Last updated
01/07/2010
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