| NPI | 1194772392 |
|---|---|
| Former Name | JOAL ANN BENNETT-BLACKMON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: MD 10646) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: DC LC00301872) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2007-07-08 |