| NPI | 1497132013 |
|---|---|
| Former Name | SHAIDA BLACKMON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 10808) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 10808) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2022-12-21 |