| NPI | 1255702080 |
|---|---|
| Former Name | JANESSA BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MI 6801105890) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.1901460) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2020-01-27 |