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General NPI Number Information
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NPI Number | 1730526013
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Entity Type | Individual
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Provider Name | ERIC J BLACK LPC
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Gender | Male
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 04/20/2025
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Provider Practice Location Address
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Address Line | 38271 MOUND RD STE 300
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-3403
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Country | US
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Telephone | 586-303-2255
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Fax | 248-266-1688
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Provider Business Mailing Address
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Address Line | 38271 MOUND RD STE 300
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City | STERLING HEIGHTS
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State | MI
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Zip | 48310-3403
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Country | US
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Telephone | 586-909-5031
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Fax | 248-266-1688
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 6401012920
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401012920
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License Number State | MI
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