| Doctor Name: | KRISTY ELEANOR BLALOCK |
| NPI Number: | 1922360247 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC, NCC |
| License Number: | 12860 |
| Business Practice Address: | 8028 Ritchie Hwy Suite 308 Pasadena, MD - 211221075 |
| Business Phone Number: | 4107610725 |
| Business Fax Number: | 4107612412 |
| Mailing Address: | 8069 Green Orchard Rd, Apt 12 GLEN BURNIE |
| State: | MD |
| Postal Code: | 210615115 |
| Phone Number: | 4432232193 |
| Fax Number: | |
| NPI Enumeration Date: | 06/12/2012 |
| NPI Last Update Date: | 07/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 12860 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MD |
| 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 |