Individual
KRISTY ELEANOR BLALOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC, NCC
Contact information
Practice address
8028 RITCHIE HWY, SUITE 308, PASADENA, MD 21122-1075
(410) 761-0725
(410) 761-2412
Mailing address
8069 GREEN ORCHARD RD, APT 12, GLEN BURNIE, MD 21061-5115
(443) 223-2193
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
12860
MD
101YA0400X
Addiction (Substance Use Disorder) Counselor
12860
MD
101YM0800X
Mental Health Counselor
12860
MD
101YP2500X
Professional Counselor
Primary
12860
MD
Other
Enumeration date
06/12/2012
Last updated
07/21/2014
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