Provider Demographics
NPI:1275000382
Name:BLACK, MEGAN (LISW-CP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 BETHEL RD UNIT 48
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5624
Mailing Address - Country:US
Mailing Address - Phone:434-229-3043
Mailing Address - Fax:
Practice Address - Street 1:811 E MAIN ST STE B1
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2004
Practice Address - Country:US
Practice Address - Phone:864-399-7472
Practice Address - Fax:864-399-7736
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC128341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical