Individual
KATHERINE LORA BLACKSTONE ALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW, MHP, CMHS
Contact information
Practice address
910 16TH AVE STE 120, LONGVIEW, WA 98632-2374
(360) 200-5419
(360) 200-6736
Mailing address
PO BOX 2394, LONGVIEW, WA 98632-8455
(360) 200-5419
(360) 200-6736
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LW60424218
WA
1041C0700X
Clinical Social Worker
Primary
LW60424218
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2122309
—
WA
Enumeration date
08/21/2009
Last updated
09/18/2023
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