Provider Demographics
NPI:1346605797
Name:BLACK, CHRIS (LCSW-BACS)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SILVERT MAIN PL
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-4045
Mailing Address - Country:US
Mailing Address - Phone:985-516-5275
Mailing Address - Fax:985-400-5164
Practice Address - Street 1:5 SILVERT MAIN PL
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-4045
Practice Address - Country:US
Practice Address - Phone:985-516-5275
Practice Address - Fax:985-400-5164
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical