Provider Information for 1780124560
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MICHAEL W BLACK LMHC
Sex: Male
NPI: 1780124560
Last Updated: 2024-05-19
Certification Date: 2024-05-19
Certification Date: 2024-05-19
Details
| Name | Value | ||||||||
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| NPI | 1780124560 | ||||||||
| Enumeration Date | 2017-02-28 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2880 DAVID WALKER DR # 237 EUSTIS, FL 32726-6172 United States Phone: 352-910-6915 | Fax: | ||||||||
| Primary Practice Address | 2880 DAVID WALKER DR # 237 EUSTIS, FL 32726-6172 United States Phone: 352-910-6915 | Fax: | ||||||||
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