Provider Demographics
NPI:1346325917
Name:BLACKBURN, CAROLYN B (MHC, RN)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:B
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:MHC, RN
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Mailing Address - Street 1:2323A E PALMDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4957
Mailing Address - Country:US
Mailing Address - Phone:661-223-3838
Mailing Address - Fax:661-945-2495
Practice Address - Street 1:349-A EAST AVENUE K-6
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535
Practice Address - Country:US
Practice Address - Phone:661-723-4260
Practice Address - Fax:661-945-2495
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN388421163WP0808X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health