Individual
LISA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5400 LAUREL SPRINGS PKWY, BLDG 400 #404, SUWANEE, GA 30024-6056
(678) 473-9954
(678) 931-0105
Mailing address
2355 ASHTON DR, ROSWELL, GA 30076-4233
(858) 472-3022
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14052341
GA
Other
Enumeration date
02/15/2016
Last updated
02/10/2020
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