| Doctor Name: | DAVID BLACKMON |
| NPI Number: | 1144338211 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | PY0004360 |
| Business Practice Address: | 330 A1a N Ste 325 Ponte Vedra Beach, FL - 320821826 |
| Business Phone Number: | 9043333389 |
| Business Fax Number: | 9047132989 |
| Mailing Address: | 330 A1a N Ste 325, PONTE VEDRA BEACH |
| State: | FL |
| Postal Code: | 320821826 |
| Phone Number: | 9043333389 |
| Fax Number: | 9047132989 |
| NPI Enumeration Date: | 08/28/2006 |
| NPI Last Update Date: | 10/10/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY0004360 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |