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General NPI Number Information
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NPI Number | 1275426397
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Entity Type | Individual
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Provider Name | RACHEL KAY BLACK
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Gender | Female
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 240 MITCHELL BRIDGE RD
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City | ATHENS
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State | GA
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Zip | 30606-2043
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Country | US
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Telephone | 855-333-9544
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Fax |
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Provider Business Mailing Address
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Address Line | 165 N 3RD ST
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City | COLBERT
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State | GA
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Zip | 30628-2931
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW009635
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License Number State | GA
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