Individual
ABIGAIL BLACKLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.P.C.
Contact information
Practice address
103 SAWMILL RD., BRECKENRIDGE, CO 80424
(970) 368-2825
Mailing address
2415 GOAT CREEK RD, KERRVILLE, TX 78028-9427
(970) 368-2825
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5861
CO
101YP2500X
Professional Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548583081
—
CO
Enumeration date
03/11/2010
Last updated
05/07/2020
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