Individual
DONNA MARIA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
605 STADIUM DR, HATTIESBURG, MS 39401-4156
(601) 450-0310
(601) 450-0321
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 450-0310
(601) 450-0321
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C0468
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05723875
—
MS
Enumeration date
11/26/2007
Last updated
07/08/2011
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