Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Willie Larry Blackmon, LCPC, CADC, MA

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1477762052

Mr. Willie Larry Blackmon, LCPC, CADC, MA is a Mental Health Counselor in Hazel Crest, Illinois. Qualified in 2001, 25 years ago. Accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
25
Licensed in
IL
In the registry since
2007
Specialties on file
3
What do these letters mean?
LCPC — Licensed Clinical Professional Counselor
A licensed clinical counsellor.
CADC — Certified Alcohol and Drug Counselor
A certified addiction counsellor.
MA — Master of Arts
A graduate arts degree.

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Practice location Address checks out

17504 E Carriageway Dr Ste B
Hazel Crest, IL 60429-2089
Phone: (708) 799-0300
Fax: (708) 799-0300
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Professional Counselor (primary) Taxonomy 101YP2500X · Licence 180.007189 (IL)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 5848 (IL)
Mental Health Counselor Taxonomy 101YM0800X · Licence 178-002766 (IL)

Record details

NPI number1477762052
Entity typeIndividual (Type 1)
GenderMale
Credentials LCPC , CADC , MA
Sole proprietorNo
NPI enumeratedMay 21, 2007
Last updated in NPPESApril 23, 2009

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyMENTAL HEALTH COUNSELOR
Medical schoolOTHER
Graduated 2001 (25 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Hazel Crest