Individual
MR. RAYMOND BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADAC II
Contact information
Practice address
832 MAIN ST SOUTH, BRUSH CREEK, TN 38547
(615) 630-8908
Mailing address
811 ROYAL ELM CIR, HARTSVILLE, TN 37074-2004
(615) 330-0161
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LDC0000001425
TN
Other
Enumeration date
08/21/2020
Last updated
09/28/2020
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