Individual provider · Type 1 NPI

Mildred Renee Black

Mental Health Counselor · Vicksburg, MS

NPI number 1154675171 Active

Practice location

3444 Wisconsin Ave
Vicksburg, MS 39180-5331

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XNone listed

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About NPI 1154675171

Mildred Renee Black's National Provider Identifier is 1154675171, issued on Oct 29, 2012. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Vicksburg, MS. The record was last updated on Oct 29, 2012.