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Organization
WILLOW GLEN
Active
Organization
WILLOW GLEN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA BLACKLEY LPCC (LPCC)
(216) 329-1052
Entity
Organization
Contact information
Practice address
30800 CHAGRIN BLVD, CLEVELAND, OH 44124-5925
(216) 329-1052
Mailing address
30800 CHAGRIN BLVD, CLEVELAND, OH 44124-5925
(216) 329-1052
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP2500X
Professional Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
08/13/2025
Last updated
08/13/2025
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