Individual
MRS. TRACEY HAWTHORNE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW., CIT
Contact information
Practice address
MEADOW LANE, UNIT 6, PINEVILLE, LA 71360
(318) 484-6400
(318) 487-5704
Mailing address
613 PENICK ST, PINEVILLE, LA 71360-5246
(318) 484-6795
(318) 487-5704
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
R1971
LA
Other
Enumeration date
08/24/2006
Last updated
07/08/2007
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