Individual
EARLEAN BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1865 WALDREP CIR SE, MARIETTA, GA 30060-4927
(678) 491-0078
Mailing address
1865 WALDREP CIR SE, MARIETTA, GA 30060-4927
(678) 239-2239
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
GA
Other
Enumeration date
06/06/2019
Last updated
06/06/2019
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