Individual
DIANE BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-C
Contact information
Practice address
5000 THAYER CTR STE C, OAKLAND, MD 21550-1139
(301) 276-4116
Mailing address
10308 GLEN VISTA DR, DALLAS, TX 75217-3582
(240) 863-8884
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
26801
MD
Other
Enumeration date
05/16/2020
Last updated
09/15/2023
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