Provider Demographics
NPI:1942505789
Name:BLACKWOOD, AUDREY PATRICIA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:PATRICIA
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 DEVON RD
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5205
Mailing Address - Country:US
Mailing Address - Phone:504-495-0600
Mailing Address - Fax:504-309-5425
Practice Address - Street 1:2601 TULANE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7462
Practice Address - Country:US
Practice Address - Phone:504-495-0600
Practice Address - Fax:504-309-5425
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3753101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional