Individual
MATTHEW DAVID BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, CDCA
Contact information
Practice address
17606 COSHOCTON RD, MOUNT VERNON, OH 43050-9218
(740) 397-7568
Mailing address
2000 NOBLE DR, WOOSTER, OH 44691-5353
(330) 264-3232
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.163972
OH
101YP2500X
Professional Counselor
Primary
C.1500475
OH
Other
Enumeration date
10/23/2017
Last updated
06/30/2020
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