Doctor Name: | CANDICE MICHELLE BLACKBURN |
NPI Number: | 1033414974 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCC |
License Number: | KY-1256 |
Business Practice Address: | 333 W Dixie Ave Elizabethtown, KY - 427011757 |
Business Phone Number: | 2707696846 |
Business Fax Number: | |
Mailing Address: | 300 Hope St, Po Box 1429 MT WASHINGTON |
State: | KY |
Postal Code: | 400477757 |
Phone Number: | 5025381000 |
Fax Number: | 5025381100 |
NPI Enumeration Date: | 01/25/2011 |
NPI Last Update Date: | 08/16/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | KY-1256 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | KY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |