Individual
JOSEPH ANDREW BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPC
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CG60311330
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG60311330
COUNSELOR AGENCY AFFILIATED REGISTRATION
WA
Enumeration date
01/24/2019
Last updated
01/24/2019
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