person
Mr. Willie Larry Blackmon, LCPC;CADC;MA
Professional Counselor in Hazel Crest, Illinois
NPI 1477762052

Willie Larry Blackmon is a Professional Counselor based in Chicago, IL and is specialized in Professional. Willie Larry Blackmon practices in Hazel Crest, IL and has the professional credentials of LCPC;CADC;MA. The NPI Number for Willie Larry Blackmon is 1477762052 and holds a License No. 5848 (Illinois).

The current practice location address for Willie Larry Blackmon is 17504 E Carriageway Dr Ste B, Hazel Crest, IL and can be reached out via phone at 708-799-0300 and via fax at 708-799-0300.

Location: 17504 E Carriageway Dr Ste B, Hazel Crest, IL, 60629-1124
person
Provider Profile Details
NPI Number
1477762052
Provider Name
Willie Larry Blackmon
Credential
LCPC;CADC;MA
Provider Entity Type
Individual
Gender
Male
Address
17504 E Carriageway Dr Ste B, Hazel Crest, IL, 60629-1124
Phone Number
708-799-0300
Fax Number
708-799-0300
Provider Enumeration Date
05/21/2007
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
17504 E Carriageway Dr Ste B
City
State
Zip
60429-2089
Phone Number
708-799-0300
Fax Number
708-799-0300
person
Provider Business Mailing Address Details
Address
17504 E Carriageway Dr Ste B
City
State
Zip
60429-2089
Phone Number
708-799-0300
Fax Number
708-799-0300
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
License No.
180.007189 (Illinois)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
License No.
178-002766 (Illinois)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
License No.
5848 (Illinois)
Definition
Definition to come...
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