Provider Demographics
NPI:1093378010
Name:BLACK, JILLIAN SARAH (MED)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:SARAH
Last Name:BLACK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 LINCOLN HWY E STE 150
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3685
Mailing Address - Country:US
Mailing Address - Phone:717-397-7625
Mailing Address - Fax:717-397-6057
Practice Address - Street 1:1929 LINCOLN HWY E STE 150
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-3685
Practice Address - Country:US
Practice Address - Phone:717-397-7625
Practice Address - Fax:717-397-6057
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor