Individual
ANISA BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3000 LATROBE DR STE B, CHARLOTTE, NC 28211-5227
(704) 612-6537
(888) 261-6694
Mailing address
7503 MISTY VIEW CT, CHARLOTTE, NC 28215-2872
(704) 501-7527
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NC
Other
Enumeration date
02/03/2021
Last updated
02/03/2021
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