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1487377784
SHANNON LEE BLACK
VICTORVILLE, CA
NPI
1487377784
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2022-09-21
Last Update Date
2022-09-21
Business Address
SHANNON LEE BLACK
16248 VICTOR ST
VICTORVILLE, CA 92395-3934
Phone number: 760-243-7151
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Mailing Address
SHANNON LEE BLACK
1000 WINDY PASS SPC 154
BARSTOW, CA 92311-5476
Phone number: 442-455-8822
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