Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 10278 | NC |
NPI | 1003246810 |
---|---|
Provider Name | Vanessa Black |
First Address | Laurinburg, NC 28352-3061 |
Second Address | Laurinburg, NC 28352-4764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2013 |
Last Update Date | 09/04/2016 |