Organization
WALISHA M. BLACKMORE M.ED., LPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WALISHA BLACKMORE LPC (LICENSED PROFESSIONAL COUNSELOR)
(409) 344-2790
Entity
Organization
Contact information
Practice address
2100 19TH ST, PORT ARTHUR, TX 77640-3859
(409) 344-2790
Mailing address
2100 19TH ST, PORT ARTHUR, TX 77640-3859
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
15296
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
028371503
—
TX
Enumeration date
10/10/2014
Last updated
10/10/2014
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