Provider Demographics
NPI:1467958892
Name:BLEVINS, CALEB RAY (CDCA II)
Entity Type:Individual
Prefix:MR
First Name:CALEB
Middle Name:RAY
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:CDCA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4561 WOOD FOREST LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1141
Mailing Address - Country:US
Mailing Address - Phone:513-668-0152
Mailing Address - Fax:
Practice Address - Street 1:621 S ERIE HWY
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-4315
Practice Address - Country:US
Practice Address - Phone:513-437-0493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163127101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)