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1497378947
GEORGIA ROSE BLACK
NEW BERLIN, WI
NPI
1497378947
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: WI 4665)
Additional Taxonomies
221700000X Art Therapist
Enumeration Date
2020-05-19
Last Update Date
2022-01-18
Business Address
GEORGIA ROSE BLACK MS
4855 S MOORLAND RD STE 150
NEW BERLIN, WI 53151-7495
Phone number: 262-432-7702
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Mailing Address
GEORGIA ROSE BLACK MS
9000 W WISCONSIN AVE # MS 958
MILWAUKEE, WI 53226-4874
Phone number: 414-266-7615
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