Provider Demographics
NPI:1124535968
Name:BLAIR, MATTHEW AARON (CDCA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
Last Name:BLAIR
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1157
Mailing Address - Country:US
Mailing Address - Phone:740-446-2085
Mailing Address - Fax:740-446-2292
Practice Address - Street 1:458 2ND AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1157
Practice Address - Country:US
Practice Address - Phone:740-446-2085
Practice Address - Fax:740-446-2292
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.165427-PRE101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)