Individual
ELISHA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 S 13TH ST STE 209, GROVER BEACH, CA 93433-2263
(805) 252-9220
Mailing address
791 PRICE ST # 307, PISMO BEACH, CA 93449-2529
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/07/2008
Last updated
03/10/2020
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