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SANDRA MARIE BLACK B A
Addiction (Substance Use Disorder) >> Counselor >> Behavioral Health & Social Service ProvidersRegistrant NPI Number: 1871793539
Individual Registrant: SANDRA MARIE BLACK B A
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
1904 RICHLAND AVE CERES, CA 95307-4562 US
Tel: 209-541-2155 Fax: --
Tel: 209-541-2155 Fax: --
Contact information for business:
1601 MARAZZI LN CERES, CA 95307-9104 US
Tel: 209-541-0135 Fax: --
Tel: 209-541-0135 Fax: --
Registration Information:
NPI: 1871793539
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 101YA0400X | Behavioral Health & Social Service Providers Counselor Addiction (Substance Use Disorder) | CA |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
