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1316338940
DEDRIA BLACK
SAN ANDREAS, CA
NPI
1316338940
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2015-02-18
Last Update Date
2015-02-18
Business Address
-- DEDRIA BLACK
891 MOUNTAIN RANCH RD
SAN ANDREAS, CA 95249-9713
Phone number: 209-754-6537
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Mailing Address
-- DEDRIA BLACK
891 MOUNTAIN RANCH RD
SAN ANDREAS, CA 95249-9713
Phone number:
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