Individual
DR. SHANNON TRICE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., LPC
Contact information
Practice address
1900 MANAKIN RD STE G, MANAKIN SABOT, VA 23103-2252
(804) 305-4642
(804) 556-3624
Mailing address
1900 MANAKIN RD, SUITE G, MANAKIN SABOT, VA 23103-2252
(804) 305-4642
(804) 556-3624
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701003122
VA
Other
Enumeration date
06/08/2015
Last updated
11/28/2016
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