Individual
CAROLLYN BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4892 N 19TH ST, MILWAUKEE, WI 53209-5757
(414) 595-3630
Mailing address
4892 N 19TH ST, MILWAUKEE, WI 53209-5757
(414) 595-3630
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18939-130
WI
Other
Enumeration date
10/15/2019
Last updated
10/15/2019
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