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General NPI Number Information
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NPI Number | 1457130684
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Entity Type | Individual
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Provider Name | CETA JANE BLACK
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Gender | Female
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 2096 E MAIN ST APT 21H
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City | SPARTANBURG
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State | SC
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Zip | 29307-1407
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Country | US
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Telephone | 336-215-0864
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Fax |
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Provider Business Mailing Address
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Address Line | 2096 EAST MAIN STREET 21H
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City | SPARTANBURG
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State | SC
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Zip | 29307-1407
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Country | US
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Telephone | 336-215-0864
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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