Organization
TAPROOT THERAPY COLLECTIVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOEL T BLACKSTOCK JR. LICSW MSW PIP (OWNER / CLINICAL DIRECTOR)
(205) 999-9240
Entity
Organization
Contact information
Practice address
2025 SHADY CREST DR, HOOVER, AL 35216-5417
(205) 999-9240
Mailing address
3204 ALTALOMA DR, VESTAVIA HILLS, AL 35216-4265
(205) 999-9240
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4135C
LICSW
AL
Enumeration date
03/29/2021
Last updated
03/31/2021
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