Provider Demographics
NPI:1376397232
Name:BLACKSHEAR, CHARLISA
Entity Type:Individual
Prefix:MRS
First Name:CHARLISA
Middle Name:
Last Name:BLACKSHEAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 SWEETBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1868
Mailing Address - Country:US
Mailing Address - Phone:614-599-9709
Mailing Address - Fax:
Practice Address - Street 1:2737 SWEETBRIAR CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1868
Practice Address - Country:US
Practice Address - Phone:614-599-9709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor