Individual
CLARISA RENEE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMBT, MMP
Contact information
Practice address
2223 NASH ST NW, WILSON, NC 27896-1735
(919) 827-7461
Mailing address
2223 NASH ST NW, WILSON, NC 27896-1735
(919) 827-7461
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
12977
NC
Other
Enumeration date
05/01/2018
Last updated
05/01/2018
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