Individual
JACQUELINE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
1030 E COUNTY LINE RD STE C1, INDIANAPOLIS, IN 46227-2998
(317) 497-6290
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
39003454A
IN
Other
Enumeration date
06/21/2019
Last updated
05/06/2025
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