MR. WILLIE LARRY BLACKMON LCPC; CADC; MA NPI 1477762052

NPI Information

NPI: 1477762052
Provider Name: MR. WILLIE LARRY BLACKMON, LCPC; CADC; MA
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

Address:
17504 E CARRIAGEWAY DR STE B
HAZEL CREST, IL
ZIP 60429
Phone: (708) 799-0300
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MR. Willie Larry Blackmon, LCPC; CADC; MA is a professional counselor in Hazel Crest, IL. MR. Willie Larry Blackmon, LCPC; CADC; MA NPI is 1477762052. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

17504 E CARRIAGEWAY DR STE B
HAZEL CREST, IL
ZIP 60429-089
Phone: (708) 799-0300
Fax: (708) 799-0300

The enumeration date for this NPI number is 5/21/2007 and was last updated on 4/23/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	5848	ILLINOIS	No
2	101YM0800X	Counselor	Mental Health	178-002766	ILLINOIS	No
3	101YP2500X	Counselor	Professional	180.007189	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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