Healthcare Provider Details

I. General information

NPI: 1982975769
Provider Name (Legal Business Name): JULIE BLAMASAH LMHC, CAP, SAP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 US HIGHWAY 98 E
SANTA ROSA BEACH FL
32459-6030
US

IV. Provider business mailing address

57 HALLELUJAH AVE
SANTA ROSA BEACH FL
32459-6085
US

V. Phone/Fax

Practice location:
  • Phone: 203-954-9211
  • Fax: 850-231-1263
Mailing address:
  • Phone: 203-954-9211
  • Fax: 850-231-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000926
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number15033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: