Provider Demographics
NPI:1598978868
Name:BLACK, JAMES DANIEL (MA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DANIEL
Last Name:BLACK
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5466
Mailing Address - Country:US
Mailing Address - Phone:717-215-5469
Mailing Address - Fax:
Practice Address - Street 1:340 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-2127
Practice Address - Country:US
Practice Address - Phone:570-366-1154
Practice Address - Fax:570-366-7711
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007734101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional