Healthcare Provider Details

I. General information

NPI: 1790154490
Provider Name (Legal Business Name): JOEL THOMAS BLACKSTOCK JR. MSW, LICSW-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 SHADY CREST DR
HOOVER AL
35216-5417
US

IV. Provider business mailing address

2025 SHADY CREST DR # 203
HOOVER AL
35216-5417
US

V. Phone/Fax

Practice location:
  • Phone: 205-598-6471
  • Fax: 205-634-3647
Mailing address:
  • Phone: 205-999-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3768G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: