| NPI | 1093191983 |
|---|---|
| Former Name | SHATASHA LENISE BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: WA LW60628629) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 091915-1) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2022-07-21 |