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Individual

MR. WILLIE LARRY BLACKMON

Active
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Individual

MR. WILLIE LARRY BLACKMON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCPC; CADC; MA

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
5848
IL
101YM0800X
Mental Health Counselor
178-002766
IL
101YP2500X
Professional Counselor
Primary
180.007189
IL

Other

Enumeration date
05/21/2007
Last updated
04/23/2009
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