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Organization
WALISHA M. BLACKMORE M.ED., LPC
Active
Organization
WALISHA M. BLACKMORE M.ED., LPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALISHA BLACKMORE LPC (LICENSED PROFESSIONAL COUNSELOR)
(409) 344-2790
Entity
Organization
Contact information
Practice address
2100 19TH ST, PORT ARTHUR, TX 77640-3859
(409) 344-2790
Mailing address
2100 19TH ST, PORT ARTHUR, TX 77640-3859
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
15296
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028371503
—
TX
Enumeration date
10/10/2014
Last updated
10/10/2014
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