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General NPI Number Information
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NPI Number | 1932653482
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Entity Type | Individual
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Provider Name | NICHOLE BLACKMON LPC
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Gender | Female
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Dates
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Enumeration Date | 08/12/2016
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 2110 BROOKS DR APARTMENT 404
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City | FORESTVILLE
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State | MD
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Zip | 20747-1064
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Country | US
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Telephone | 202-431-6266
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 BROOKS DR APARTMENT 404
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City | FORESTVILLE
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State | MD
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Zip | 20747-1064
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Country | US
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Telephone | 202-431-6266
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC6529
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC14727
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License Number State | DC
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