Individual
ALEXIS BLACKMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1444 FENWICK DR SW, MARIETTA, GA 30064-2779
(678) 561-3868
Mailing address
4405 MALL BLVD, UNION CITY, GA 30291-2044
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW010705
GA
Other
Enumeration date
03/29/2023
Last updated
05/09/2023
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