Individual
SARA REBECCA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 442-7121
Mailing address
425 BROADWAY ST, PADUCAH, KY 42001-0713
(270) 442-7121
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
288759
KY
Other
Enumeration date
01/29/2019
Last updated
06/17/2024
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