Individual
ROBERT D BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC, CRC
Contact information
Practice address
518 N DARWOOD AVE, SAN DIMAS, CA 91773-1600
(626) 628-7373
Mailing address
518 N DARWOOD AVE, SAN DIMAS, CA 91773-1600
(626) 628-7373
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
LPC007406
GA
101YP2500X
Professional Counselor
Primary
LPC308
CA
225C00000X
Rehabilitation Counselor
108223
CA
225C00000X
Rehabilitation Counselor
108223
GA
Other
Enumeration date
12/01/2017
Last updated
09/24/2024
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