Provider Demographics
NPI:1316556343
Name:BLACK, ANNA LILA (LPC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LILA
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:COUNSELORS
Other - Middle Name:
Other - Last Name:OFFICE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLC
Mailing Address - Street 1:107 OGLETHORPE PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3623
Mailing Address - Country:US
Mailing Address - Phone:912-353-7699
Mailing Address - Fax:912-353-9879
Practice Address - Street 1:107 OGLETHORPE PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3623
Practice Address - Country:US
Practice Address - Phone:912-353-7699
Practice Address - Fax:912-353-9879
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC003842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty