Black, Dedria

Black, Dedria is an individual health care provider with primary practice located at 891 Mountain Ranch Rd , San Andreas CA 95249-9713. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Black, Dedria can be contacted via phone (209) 754-6537.

Contact Information

Primary practice address
891 Mountain Ranch Rd San Andreas CA 95249-9713
Phone: (209) 754-6537
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X

Profile Details

NPI number 1316338940
LBN Legal business name Black, Dedria
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 18th, 2015
Last updated Feb 18th, 2015 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Popular Providers