Individual
LYDIA C.W. BLACKMAN-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
128 GORDAN AVENUE S., LEHIGH ACRES, FL 33973
(239) 603-5425
(239) 603-5425
Mailing address
P.O. BOX 1483, LEHIGH ACRES, FL 33970
(239) 603-5425
(239) 603-5425
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
104100000X
Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
684252679
—
FL
Enumeration date
08/02/2012
Last updated
08/02/2012
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