Individual
L. DIANE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMFT
Contact information
Practice address
4301 CARTER CREEK PKWY, SUITE 212, BRYAN, TX 77802-4485
(979) 299-8315
Mailing address
PO BOX 69, NEW BADEN, TX 77870-0069
(979) 299-8315
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
200999
TX
Other
Enumeration date
12/06/2012
Last updated
12/06/2012
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