Individual
DAISIREE LAUREN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
APS.005184
OH
405300000X
Prevention Professional
Primary
OCPSA.161732
OH
Other
Enumeration date
06/02/2023
Last updated
03/20/2025
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