Basic Information
| Provider Information | |||||||||
| NPI: | 1790154490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACKSTOCK | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MSW, LGSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 RALEIGH AVE | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059999240 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1720 2ND AVE. SOUTH | ||||||||
| Address2: | CCB 4TH FLOOR | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352942050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344108 | ||||||||
| FaxNumber: | 2059758950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2015 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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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 | 104100000X | 3768G | AL | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.