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SANDRA MARIE BLACK B A

Addiction (Substance Use Disorder) >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1871793539

Individual Registrant:
 SANDRA MARIE BLACK B A
Gender: F
Sole Proprietor

Location and contact information for practice:
1904 RICHLAND AVE  CERES, CA 95307-4562 US
Tel: 209-541-2155  Fax: --

Contact information for business:
1601 MARAZZI LN  CERES, CA 95307-9104 US
Tel: 209-541-0135  Fax: --

Registration Information:
NPI: 1871793539
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
CA

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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