Provider Demographics
NPI:1568649937
Name:BLACKWOOD, SAMUEL AUSTIN (CADC, CAS)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:AUSTIN
Last Name:BLACKWOOD
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Gender:M
Credentials:CADC, CAS
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Mailing Address - Street 1:11596 CYPRESS CANYON PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3582
Mailing Address - Country:US
Mailing Address - Phone:559-212-0389
Mailing Address - Fax:559-582-9201
Practice Address - Street 1:3148 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4539
Practice Address - Country:US
Practice Address - Phone:619-363-0853
Practice Address - Fax:619-362-9905
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2024-01-09
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Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAC3881214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)