Individual
BATHSHEVA BLACKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MFT-INTERN
Contact information
Practice address
2419 HOLLYWOOD BLVD, HOLLYWOOD, FL 33020-6605
(954) 361-4535
Mailing address
5051 N 37TH ST, HOLLYWOOD, FL 33021-2242
(213) 709-7001
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
IMT4162
FL
Other
Enumeration date
11/27/2024
Last updated
11/27/2024
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