Individual
MINDIE M BLACKSHEAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
196 SCOGGINS DR, DEMOREST, GA 30535-5354
(706) 894-3712
Mailing address
196 SCOGGINS DR, DEMOREST, GA 30535-5354
(706) 894-3712
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC012752
GA
Other
Enumeration date
03/10/2022
Last updated
03/10/2022
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