| NPI | 1033414974 |
|---|---|
| Former Name | CANDICE MICHELLE BLACKBURN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: KY KY-1256) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: KY KY-1256) |
| Enumeration Date | 2011-01-25 |
| Last Update Date | 2022-08-17 |