Healthcare Provider Details

I. General information

NPI: 1215498209
Provider Name (Legal Business Name): BLAIR OXFORD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2019
Last Update Date: 03/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8817 BAINBRIDGE DR
DAPHNE AL
36526-8331
US

IV. Provider business mailing address

8817 BAINBRIDGE DR
DAPHNE AL
36526-8331
US

V. Phone/Fax

Practice location:
  • Phone: 251-304-9317
  • Fax:
Mailing address:
  • Phone: 205-903-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2915
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: