Individual
MARY BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPRC
Contact information
Practice address
50430 SCHOOL HOUSE RD, CANTON, MI 48187-5910
(734) 431-2357
Mailing address
50430 SCHOOL HOUSE RD, CANTON, MI 48187-5910
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/25/2021
Last updated
03/25/2021
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