Provider Demographics
NPI:1578005245
Name:BLACKWELL, FRANCES AMANDA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:FRANCES
Middle Name:AMANDA
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:815 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3746
Mailing Address - Country:US
Mailing Address - Phone:919-274-3856
Mailing Address - Fax:
Practice Address - Street 1:6255 TOWNCENTER DR STE 893
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9376
Practice Address - Country:US
Practice Address - Phone:336-794-6734
Practice Address - Fax:336-792-2671
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0069121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical