Individual
MICHELLE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCDP, LMHC-A
Contact information
Practice address
610 WAMPANOAG TRL, RIVERSIDE, RI 02915-1504
(401) 246-1195
Mailing address
610 WAMPANOAG TRL, RIVERSIDE, RI 02915-1504
(401) 246-1195
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDP00634
RI
101YM0800X
Mental Health Counselor
MHC00206-A
RI
Other
Enumeration date
04/16/2010
Last updated
10/28/2025
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