Black, Donna Maria

Black, Donna Maria is an individual health care provider with primary practice located at 605 Stadium Dr , Hattiesburg MS 39401-4156. She recently has only one registered license in Behavioral Health & Social Service Providers / Social Worker, which is considered as her primary health care specialty. Black, Donna Maria can be contacted via phone (601) 450-0310.

Contact Information

Primary practice address
605 Stadium Dr Hattiesburg MS 39401-4156
Phone: (601) 450-0310
Fax: (601) 450-0321
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Social Worker 104100000X C0468 Mississippi

Profile Details

NPI number 1649451113
LBN Legal business name Black, Donna Maria
Credentials Licensed Clinical Social Worker (LCSW)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 26th, 2007
Last updated Jul 8th, 2011 - about 15 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649451113 NPPES
Mississippi MEDICAID 05723875

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