LAURA BRIMM BLACK Social Worker License verification

Business Entity

INACTIVE

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149004617

License Status

INACTIVE

Business

First Name

LAURA

Last Name

BRIMM BLACK

Business Name

LAURA BRIMM BLACK

Original Issue Date

04/03/1992

Effective Date

11/30/2009

Expiration Date

11/30/2011

City

CHATHAM

State

Zip

62629

County

SANGAMON

Specialty/Qualifier

MASTERS

Ever Disciplined

LastModifiedDate

09/07/2011