Individual
HEATHER BLACKFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMHC
Contact information
Practice address
922 E WAYNE ST STE 205-206, SOUTH BEND, IN 46617-3016
(574) 280-8199
(574) 516-8039
Mailing address
922 E WAYNE ST STE 205-206, SOUTH BEND, IN 46617-3016
(574) 280-8199
(574) 516-8039
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39003198A
IN
101YM0800X
Mental Health Counselor
LAC-14045
AZ
Other
Enumeration date
07/28/2017
Last updated
11/23/2020
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