Provider Demographics
NPI:1528512597
Name:BLACK, SABRINA DIANA (LLPC)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:DIANA
Last Name:BLACK
Suffix:
Gender:F
Credentials:LLPC
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:16250 NORTHLAND DR STE 374
Mailing Address - Street 2:CROSSROADS BLDG, NEED TO TALK, LLC
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5228
Mailing Address - Country:US
Mailing Address - Phone:248-872-3788
Mailing Address - Fax:
Practice Address - Street 1:16250 NORTHLAND DR STE 374
Practice Address - Street 2:CROSSROADS BLDG, NEED TO TALK, LLC
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5228
Practice Address - Country:US
Practice Address - Phone:248-872-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional