Individual
AVERY BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSWA
Contact information
Practice address
68 STEWART TOWN RD, LILLINGTON, NC 27546-6398
(910) 929-2103
Mailing address
4861 PINNACLE DR, STONE MOUNTAIN, GA 30088-2374
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C015629
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891205928
—
NC
Enumeration date
10/03/2017
Last updated
12/16/2025
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