WILLIE LARRY BLACKMON

HAZEL CREST, IL
NPI1477762052
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YP2500X Counselor, Professional
(Licence: IL  180.007189)
Additional Taxonomies101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: IL  5848)
101YM0800X Counselor, Mental Health
(Licence: IL  178-002766)
Enumeration Date2007-05-21
Last Update Date2009-04-23
Business Address
Mr. WILLIE LARRY BLACKMON LCPC; CADC; MA
17504 E CARRIAGEWAY DR STE B
HAZEL CREST, IL 60429-2089
Phone number: 708-799-0300
Mailing Address
Mr. WILLIE LARRY BLACKMON LCPC; CADC; MA
5834 S MAPLEWOOD AVE
CHICAGO, IL 60629-1124
Phone number: 773-778-4835