Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 0701005401 | VA |
Y | 101YP2500X | Professional Counselor | 2278 | WV |
N | 101YP2500X | Professional Counselor | 275728 | NC |
N | 101YP2500X | Professional Counselor | 8388 | NC |
N | 101YP2500X | Professional Counselor | A8388 | NC |
NPI | 1003110198 |
---|---|
Provider Name | Dr. Judith Ann Black |
First Address | Fairmont, WV 26554-1257 |
Second Address | Fairmont, WV 26554-2710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2011 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
WVTPID009357 | (05) | WV |