Provider Demographics
NPI:1891882064
Name:BLOCKER, MITCHELL B (LMHC, CAP, NCC)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:B
Last Name:BLOCKER
Suffix:
Gender:M
Credentials:LMHC, CAP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53589
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31995-3589
Mailing Address - Country:US
Mailing Address - Phone:706-545-8372
Mailing Address - Fax:706-545-8364
Practice Address - Street 1:7950 MARTIN LOOP BLDG 324
Practice Address - Street 2:FT BENNING ASAP
Practice Address - City:FT. BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-545-8372
Practice Address - Fax:706-545-8364
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH- 8628101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)