Individual
DAVID S BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CMHT
Contact information
Practice address
727 W 21ST ST, LAUREL, MS 39440-2235
(601) 705-1901
Mailing address
727 W 21ST ST, LAUREL, MS 39440-2235
(601) 705-1901
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0682
MS
Other
Enumeration date
08/14/2009
Last updated
08/14/2009
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