Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1033877600 |
---|---|
Provider Name | Arthnel Anthony Blackwood |
First Address | Marietta, GA 30064-6000 |
Second Address | Marietta, GA 30064-6000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2021 |
Last Update Date | 01/12/2021 |