Provider Demographics
NPI:1578626750
Name:BLACKWOOD, CHIDALE MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:CHIDALE
Middle Name:MARIE
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHIDALE
Other - Middle Name:MARIE
Other - Last Name:BLACKWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:121 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-3026
Mailing Address - Country:US
Mailing Address - Phone:706-699-5682
Mailing Address - Fax:
Practice Address - Street 1:121 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-3026
Practice Address - Country:US
Practice Address - Phone:706-699-5682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
GALPC005525101YP2500X
SC8599101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional