Individual
JACOB STEPHEN BLACKSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCMHCA
Contact information
Practice address
231 N SPRING ST, GREENSBORO, NC 27401-2231
(336) 899-8800
Mailing address
3026 STRATFORD DR, GREENSBORO, NC 27408-2625
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
A13081
NC
Other
Enumeration date
01/21/2021
Last updated
01/21/2021
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