Doctor Name: | MR. JOHN H BLACKSHEAR |
NPI Number: | 1174644579 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 2894 |
Business Practice Address: | 149 Us Highway 70 W Garner, NC - 275293942 |
Business Phone Number: | 9193296001 |
Business Fax Number: | 9196627883 |
Mailing Address: | 149 Us Highway 70 W, GARNER |
State: | NC |
Postal Code: | 275293942 |
Phone Number: | 9193296001 |
Fax Number: | 9196627883 |
NPI Enumeration Date: | 04/03/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2894 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |