Provider Demographics
NPI:1821871815
Name:BLACK, CASSIE LEIGH
Entity Type:Individual
Prefix:MS
First Name:CASSIE
Middle Name:LEIGH
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 INTERSTATE 30
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-7027
Mailing Address - Country:US
Mailing Address - Phone:501-737-4320
Mailing Address - Fax:
Practice Address - Street 1:103 CALVARY LN
Practice Address - Street 2:
Practice Address - City:JUDSONIA
Practice Address - State:AR
Practice Address - Zip Code:72081-9324
Practice Address - Country:US
Practice Address - Phone:501-737-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator