Individual
DIANA BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
508 N TRUMAN BLVD STE F, CRYSTAL CITY, MO 63019-1344
(636) 931-8784
(636) 465-0026
Mailing address
508 N TRUMAN BLVD STE F, CRYSTAL CITY, MO 63019-1344
(636) 931-8784
(636) 465-0026
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
005911
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
493964837
—
MO
Enumeration date
09/27/2006
Last updated
05/14/2025
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