Individual
MR. JUSTIN LEE BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAP, ICADC, CAC-AD
Contact information
Practice address
1415 HOMESTEAD RD N, LEHIGH ACRES, FL 33936-4830
(239) 491-8092
(239) 491-9213
Mailing address
1415 HOMESTEAD RD N, LEHIGH ACRES, FL 33936-4830
(239) 491-8092
(239) 491-9213
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
AC2946
MD
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CAP.0100424
FL
101YA0400X
Addiction (Substance Use Disorder) Counselor
ICADC.0000031
FL
175T00000X
Peer Specialist
PR0153
MD
Other
Enumeration date
09/04/2017
Last updated
05/20/2023
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