Provider Demographics
NPI:1386058816
Name:BLOUNT, SHACARRA (MED)
Entity type:Individual
Prefix:
First Name:SHACARRA
Middle Name:
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BOB WHITE DR.
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042
Mailing Address - Country:US
Mailing Address - Phone:931-378-1657
Mailing Address - Fax:
Practice Address - Street 1:1820 MEMORIAL CIRCLE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043
Practice Address - Country:US
Practice Address - Phone:931-933-7200
Practice Address - Fax:931-896-2075
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor