Provider Demographics
NPI:1184061442
Name:BLAIR, JACQUELINE (AAS, CADC-M, CCS-M)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:AAS, CADC-M, CCS-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 W DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-4094
Mailing Address - Country:US
Mailing Address - Phone:810-931-3092
Mailing Address - Fax:
Practice Address - Street 1:529 M L KING AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-2002
Practice Address - Country:US
Practice Address - Phone:810-238-0483
Practice Address - Fax:810-239-5518
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)