Individual
ANTOINETTE MARINO BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
9165 OTIS AVE STE 103, INDIANAPOLIS, IN 46216-2307
(317) 847-5697
Mailing address
6904 N LAREDO DR, MC CORDSVILLE, IN 46055-6048
(317) 847-5697
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
35001409A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100270530
—
IN
Enumeration date
04/18/2006
Last updated
04/20/2020
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