Individual
SONI ELIZABETH BLACKBURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
215 KIRKLAND RD, COVINGTON, GA 30016-3318
(678) 209-2770
Mailing address
215 KIRKLAND RD, COVINGTON, GA 30016-3318
(678) 209-2770
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW010507
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070281497
GEORGIA DMV
GA
Enumeration date
11/15/2022
Last updated
11/15/2022
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