Provider Demographics
NPI:1912505413
Name:BLACKSTOCK LLC
Entity Type:Organization
Organization Name:BLACKSTOCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BLACKSTOCK
Authorized Official - Suffix:JR
Authorized Official - Credentials:LICSW MSW PIP
Authorized Official - Phone:205-999-9240
Mailing Address - Street 1:3204 ALTALOMA DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4265
Mailing Address - Country:US
Mailing Address - Phone:205-999-9240
Mailing Address - Fax:
Practice Address - Street 1:2025 SHADY CREST DR STE 203
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-5417
Practice Address - Country:US
Practice Address - Phone:205-999-9240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty