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General NPI Number Information
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NPI Number | 1124239538
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Entity Type | Individual
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Provider Name | WENDY J BLACKWOOD MS, LAC, NCC
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Gender | Female
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 03/19/2015
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Provider Practice Location Address
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Address Line | 1422 CALDWELL ST
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City | CONWAY
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State | AR
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Zip | 72034-5319
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Country | US
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Telephone | 501-327-7224
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Fax | 501-327-7224
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Provider Business Mailing Address
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Address Line | 1422 CALDWELL ST
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City | CONWAY
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State | AR
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Zip | 72034-5319
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Country | US
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Telephone | 501-327-7224
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Fax | 501-327-7224
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P0801005
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | P0801005
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License Number State | AR
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