Provider Demographics
NPI:1124239538
Name:BLACKWOOD, WENDY J (MS, LAC, NCC)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:J
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:MS, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5319
Mailing Address - Country:US
Mailing Address - Phone:501-327-7224
Mailing Address - Fax:501-327-7224
Practice Address - Street 1:1422 CALDWELL ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5319
Practice Address - Country:US
Practice Address - Phone:501-327-7224
Practice Address - Fax:501-327-7224
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0801005101YP2500X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist