Individual
MR. WILLIAM BLACKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCADC
Contact information
Practice address
7131 RUTHERFORD RD, BALTIMORE, MD 21244-2702
(410) 298-2691
(410) 298-0835
Mailing address
1331 SUGARWOOD CIR, BALTIMORE, MD 21221-5449
(410) 686-1272
(410) 298-0835
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
011538
MD
Other
Enumeration date
01/10/2007
Last updated
07/08/2007
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