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Contact Information

WILLIE L BLACKMON, LCPC; CADC; MA
5834 S. MAPLEWOOD AVE.
CHICAGO, IL60629
 Phone: 773-934-5668
 Fax: 773-778-4835
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Professional

101YP2500X
 

Addiction (Substance Use Disorder)

101YA0400X
 

Mental Health

101YM0800X
Indicates primary specialty

NPI Profile & details for WILLIE L BLACKMON · (Male)

NPI # 1477762052
Status Active
Credentials LCPC; CADC; MA
Entity Individual
Enumeration date 05/21/2007
Last updated 04/23/2009 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 178-002766
  • IL License # 180.007189
  • IL License # 5848
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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