NPI | 1194772392 |
---|---|
Former Name | JOAL ANN BENNETT-BLACKMON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
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 |