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Individual

AMANDA LOUISE BLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
SUDPT

Contact information

Practice address
230 E STATE ST, MOSSYROCK, WA 98564-2501
(360) 266-5585
(360) 262-6620
Mailing address
PO BOX 1371, CHEHALIS, WA 98532-0340
(360) 266-5585

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CO61208402
WA

Other

Enumeration date
10/17/2023
Last updated
10/17/2023
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