Provider Demographics
NPI:1790154490
Name:BLACKSTOCK, JOEL THOMAS JR (MSW, LGSW)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:THOMAS
Last Name:BLACKSTOCK
Suffix:JR
Gender:M
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 RALEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-999-9240
Mailing Address - Fax:
Practice Address - Street 1:1720 2ND AVE. SOUTH
Practice Address - Street 2:CCB 4TH FLOOR
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-2050
Practice Address - Country:US
Practice Address - Phone:205-934-4108
Practice Address - Fax:205-975-8950
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3768G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker