Basic Information
| Provider Information | |||||||||
| NPI: | 1467958892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLEVINS | ||||||||
| FirstName: | CALEB | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CDCA II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4561 WOOD FOREST LN | ||||||||
| Address2: | |||||||||
| City: | BATAVIA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451031141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136680152 | ||||||||
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| Practice Location | |||||||||
| Address1: | 621 S ERIE HWY | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450114315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134370493 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 04/11/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 163127 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.