NPI Profile for WILLIE L BLACKMON in CHICAGO, IL.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Professional |
101YP2500X | |||
Addiction (Substance Use Disorder) |
101YA0400X | |||
Mental Health |
101YM0800X |
| 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 |
|
|
| Hospital affiliation(s) | Not Available |
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WILLIE L BLACKMON
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