Provider Demographics
NPI:1336225077
Name:BLACKWOOD, DEVON ANTHONY (LCADC)
Entity Type:Individual
Prefix:MR
First Name:DEVON
Middle Name:ANTHONY
Last Name:BLACKWOOD
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
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Mailing Address - Street 1:10400 RIDGLAND ROAD
Mailing Address - Street 2:STE 1
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030
Mailing Address - Country:US
Mailing Address - Phone:410-628-6120
Mailing Address - Fax:410-628-9825
Practice Address - Street 1:100 OWINGS COURT
Practice Address - Street 2:STE 8
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-526-7100
Practice Address - Fax:410-526-7138
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDLCA305101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)