| Amanda Louise Black, SUDPT | |
|
230 E State St, Mossyrock, WA 98564-2501 | |
| (360) 266-5585 | |
| (360) 262-6620 |
| Full Name | Amanda Louise Black |
|---|---|
| Gender | Female |
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 230 E State St, Mossyrock, Washington |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538941273 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | CO61208402 (Washington) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda Louise Black, SUDPT Po Box 1371, Chehalis, WA 98532-0340 Ph: (360) 266-5585 | Amanda Louise Black, SUDPT 230 E State St, Mossyrock, WA 98564-2501 Ph: (360) 266-5585 |
David Richard Baldwin, CP00006153 Counselor Medicare: Not Enrolled in Medicare Practice Location: 230 East State Street, Mossyrock, WA 98564 Phone: 360-983-3257 | |
Mr. Jack Otto Lehmann, Counselor Medicare: Not Enrolled in Medicare Practice Location: 230 E State St, Mossyrock, WA 98564 Phone: 360-983-3227 Fax: 360-983-3289 |