Individual
ANITA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
182 MIDDLETON PARK LN, MOORE, SC 29369-7800
(864) 804-2166
Mailing address
182 MIDDLETON PARK LN, MOORE, SC 29369-7800
(864) 804-2166
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87-0998726
EINS
SC
Enumeration date
07/26/2023
Last updated
07/26/2023
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