| Doctor Name: | GRACE M BLACKWOOD |
| NPI Number: | 1104071133 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | LPC004495 |
| Business Practice Address: | 570 Windsor Way Fairburn, GA - 302136446 |
| Business Phone Number: | 7703653140 |
| Business Fax Number: | 7707037915 |
| Mailing Address: | 570 Windsor Way, FAIRBURN |
| State: | GA |
| Postal Code: | 302136446 |
| Phone Number: | 7703653140 |
| Fax Number: | 7707037915 |
| NPI Enumeration Date: | 11/18/2008 |
| NPI Last Update Date: | 01/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LPC004495 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |