Individual
ALICIA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
171 DEEP WOOD DR STE 104, ROUND ROCK, TX 78681-4935
(512) 910-3251
Mailing address
13628 GREGG MANOR RD, MANOR, TX 78653-3358
(720) 435-6189
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
25-499179
TX
Other
Enumeration date
01/06/2026
Last updated
01/06/2026
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