Individual
EBONY LASHA BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 E 7TH ST STE 100, CHARLOTTE, NC 28204-6301
(704) 780-4271
Mailing address
3308 REHOBETH CHURCH RD APT Q, GREENSBORO, NC 27406-5038
(336) 987-9895
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NC
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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