Individual provider · Type 1 NPI

Willie Larry Blackmon, LCPC; CADC; MA

Professional Counselor · Hazel Crest, IL

NPI number 1477762052 Active

Practice location

17504 E Carriageway Dr Ste B
Hazel Crest, IL 60429-2089

Call (708) 799-0300 Map

Fax (708) 799-0300

Mailing address

5834 S Maplewood Ave
Chicago, IL 60629-1124

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor 101YA0400X5848 (IL)
Mental Health Counselor 101YM0800X178-002766 (IL)
Professional Counselor Primary 101YP2500X180.007189 (IL)

Professional Counselor: Definition to come...

2 other providers at this address

Other professional counselor providers in Hazel Crest

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About NPI 1477762052

Willie Larry Blackmon, LCPC; CADC; MA's National Provider Identifier is 1477762052, issued on May 21, 2007. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Hazel Crest, IL. The record was last updated on Apr 23, 2009.