Individual
MISS MICAELA T BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
107 CLOCK TOWER SQ, SUITE 107, PORTSMOUTH, RI 02871-1396
(401) 255-4299
Mailing address
163 N CHRISTOPHER AVE, TIVERTON, RI 02878-3885
(401) 255-4299
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MHC00421
RI
171M00000X
Case Manager/Care Coordinator
0005601
RI
Other
Enumeration date
07/11/2009
Last updated
07/11/2009
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