Individual
MARY BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1427 OAKLAND ST, SAINT CLAIR, MI 48079-5122
(810) 650-5902
(800) 305-6764
Mailing address
1427 OAKLAND ST, SAINT CLAIR, MI 48079-5122
(810) 650-5902
(800) 305-6764
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81-4065881
FEIN
MI
Enumeration date
11/11/2016
Last updated
11/11/2016
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