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General NPI Number Information
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NPI Number | 1639759251
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Entity Type | Individual
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Provider Name | MARCIA BLALOCK BROWN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/08/2021
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Last Update Date | 04/08/2021
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Provider Practice Location Address
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Address Line | 6033 ALKIRE CT
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City | ARVADA
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State | CO
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Zip | 80004-3971
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Country | US
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Telephone | 720-675-7643
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Fax |
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Provider Business Mailing Address
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Address Line | 12650 W 64TH AVE UNIT E193
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City | ARVADA
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State | CO
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Zip | 80004-3893
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Country | US
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Telephone | 720-675-7643
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09925852
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License Number State | CO
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