Provider Information for 1871907535
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DENISE MICHELLE BLACK LPC
Sex: Female
NPI: 1871907535
Last Updated: 2019-07-22
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
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| NPI | 1871907535 | ||||||||||||||
| Enumeration Date | 2014-06-20 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | YES | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 272 S COLUMBIA AVE RINCON, GA 31326-9026 United States Phone: 912-713-9533 | Fax:912-826-1245 | ||||||||||||||
| Primary Practice Address | 6555 ABERCORN ST SUITE 221 SAVANNAH, GA 31405-5713 United States Phone: 912-200-9818 | Fax:912-200-9819 | ||||||||||||||
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