Provider Demographics
NPI:1871907535
Name:BLACK, DENISE MICHELLE (LPC)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MICHELLE
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:272 S COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-9026
Mailing Address - Country:US
Mailing Address - Phone:912-713-9533
Mailing Address - Fax:912-826-1245
Practice Address - Street 1:6555 ABERCORN ST
Practice Address - Street 2:SUITE 221
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5713
Practice Address - Country:US
Practice Address - Phone:912-200-9818
Practice Address - Fax:912-200-9819
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-20
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GALPC007833101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional