Individual
MRS. TRACY J BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
2262 N MONROE ST, MONROE, MI 48162-4254
(734) 430-9394
(734) 687-6198
Mailing address
PO BOX 2452, MONROE, MI 48161-7452
(734) 819-1747
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6401010214
MI
Other
Enumeration date
05/16/2007
Last updated
05/27/2016
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