| NPI | 1316323520 |
|---|---|
| Former Name | JESSICA ELLIN BLACK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701006034) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 8524) |
| 101YM0800X Counselor, Mental Health (Licence: TX 80611) | |
| 101YM0800X Counselor, Mental Health (Licence: MD LC12257) | |
| 101YM0800X Counselor, Mental Health (Licence: RI MHC00927) | |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2025-10-07 |