SUSAN E BLACK Social Worker License verification

Business Entity

NOT RENEWED

License Type

Social Worker

Description

LICENSED CLINICAL SOCIAL WORKER

License Number

149005088

License Status

NOT RENEWED

Business

First Name

SUSAN E

Last Name

BLACK

Business Name

SUSAN E BLACK

Original Issue Date

10/01/1992

Effective Date

01/14/2004

Expiration Date

11/30/2003

City

BLOOMINGTON

State

Zip

61704

County

MCLEAN

Specialty/Qualifier

MASTERS

Ever Disciplined

LastModifiedDate

10/28/2006