Individual
CONNIE FAYE BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1830 E OLIVE RD, PENSACOLA, FL 32514-7582
(850) 473-4461
Mailing address
2233 E OLIVE RD STE 1, PENSACOLA, FL 32514-6153
(850) 860-2714
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
19265
FL
Other
Enumeration date
02/18/2020
Last updated
02/18/2020
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