Individual
MINA-AYESHA A BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
2062 OLD LYCOMING RAOD, WILLIAMSPORT, PA 17701
(570) 505-1123
Mailing address
65 GRATZMAR AVE, RENOVO, PA 17764-9507
(570) 858-0046
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
SW123316
PA
Other
Enumeration date
07/07/2006
Last updated
06/23/2014
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