Provider Information for 1235500851
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TANIKA BLACK MA, LPC, BSN, RN
Sex: Female
NPI: 1235500851
Last Updated: 2023-05-18
Certification Date: 2023-05-18
Certification Date: 2023-05-18
Details
Name | Value | ||||||||||||
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NPI | 1235500851 | ||||||||||||
Enumeration Date | 2015-10-08 | ||||||||||||
NPI Type | NPI-1 Individual | ||||||||||||
Sole Proprietor | YES | ||||||||||||
Status | Active | ||||||||||||
Mailing Address | 518 JOEL ST MINDEN, LA 71055-5206 United States Phone: 318-268-5330 | Fax:318-377-5868 | ||||||||||||
Primary Practice Address | 518 JOEL ST MINDEN, LA 71055-5206 United States Phone: 318-268-5330 | Fax:318-377-5868 | ||||||||||||
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