Provider Demographics
NPI:1245956846
Name:BLACK, STEPHEN ROCKWELL (LMHCA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:ROCKWELL
Last Name:BLACK
Suffix:
Gender:M
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 NE PARKWAY DR STE 130
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6648
Mailing Address - Country:US
Mailing Address - Phone:971-212-2046
Mailing Address - Fax:
Practice Address - Street 1:7700 NE PARKWAY DR STE 130
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6648
Practice Address - Country:US
Practice Address - Phone:971-212-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61329324101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health