Individual
DEBORA L. BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
240 S MONTEZUMA ST, PRESCOTT, AZ 86303-4712
(844) 384-7223
Mailing address
240 S MONTEZUMA ST STE 106, PRESCOTT, AZ 86303-4712
(844) 384-7223
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-20734
AZ
Other
Enumeration date
10/28/2022
Last updated
10/28/2022
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