# MR. JUSTIN LEE BLACKWELL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1871011486
- **Gender:** Man
- **Credential:** CAP, ICADC, CAC-AD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | AC2946 | MD | — |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | CAP.0100424 | FL | Yes |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | ICADC.0000031 | FL | — |
| 175T00000X | Peer Specialist | PR0153 | MD | — |

## Other

- **Enumeration date:** 09/04/2017
- **Last updated:** 05/20/2023