Provider Demographics
NPI:1891544870
Name:BLACKWELL, ALICE (MED, EDS, LPC-A)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MED, EDS, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SYCAMORE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2965
Mailing Address - Country:US
Mailing Address - Phone:864-238-9348
Mailing Address - Fax:
Practice Address - Street 1:8 SYCAMORE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2965
Practice Address - Country:US
Practice Address - Phone:864-534-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8547101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor