Individual
NICKOLAS BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1022 MAIN ST, CONWAY, AR 72032-5426
(501) 609-0400
Mailing address
1022 MAIN ST, CONWAY, AR 72032-5426
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
P2108000
AR
Other
Enumeration date
09/30/2016
Last updated
10/04/2021
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