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General NPI Number Information
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NPI Number | 1942924741
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Entity Type | Individual
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Provider Name | KELLI JO BLAIR B.S.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | WILLIAMSON COMPREHENSIVE TREATMENT CENTER INC. 1609 WEST THIRD AVENUE
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City | WILLIAMSON
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State | WV
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Zip | 25661
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Country | US
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Telephone | 304-235-0026
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Fax |
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Provider Business Mailing Address
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Address Line | 835 BIG LICK RD
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City | INEZ
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State | KY
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Zip | 41224-8855
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Country | US
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Telephone | 606-626-0049
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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