MEDICARE: MR. ERIC J BLACK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	6401012920	MI
2	101YP2500X	Professional Counselor	6401012920	MI

General Provider Information

NPI Number	:	1730526013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC J BLACK LPC

Provider Business Mailing Address
First Line	:	38271 MOUND RD STE 300
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3403
Country	:	US
Telephone Number	:	586-909-5031
Fax Number	:	248-266-1688

Provider Business Practice Location Address
First Line	:	38271 MOUND RD STE 300
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-3403
Country	:	US
Telephone Number	:	586-303-2255
Fax Number	:	248-266-1688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	04/20/2025

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