Provider Demographics
NPI:1447705322
Name:BLACKWELL, YAKIYAH
Entity type:Individual
Prefix:
First Name:YAKIYAH
Middle Name:
Last Name:BLACKWELL
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 1:1285 MOREHEAD PL
Mailing Address - Street 2:APT 307
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2017
Mailing Address - Country:US
Mailing Address - Phone:803-316-1443
Mailing Address - Fax:
Practice Address - Street 1:1285 MOREHEAD PL
Practice Address - Street 2:APT 307
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2017
Practice Address - Country:US
Practice Address - Phone:803-316-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor