Healthcare Provider Details

I. General information

NPI: 1891471033
Provider Name (Legal Business Name): FAITH BLAIR LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 VIKING DR
WAREHAM MA
02571-1467
US

IV. Provider business mailing address

12 TRINAS PATH
PLYMOUTH MA
02360-4729
US

V. Phone/Fax

Practice location:
  • Phone: 508-291-3550
  • Fax:
Mailing address:
  • Phone: 949-874-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: