| Blackwest, Llc | |
|
703 Atlanta Rd Cumming GA 30040-2705 | |
| (770) 886-6204 | |
| Not Available |
| Full Name | Blackwest, Llc |
|---|---|
| Speciality | Behavior Analyst |
| Location | 703 Atlanta Rd, Cumming, Georgia |
| Authorized Official Name and Position | Hailey Blackstock (CEO) |
| Authorized Official Contact | 6789650653 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackwest, Llc 703 Atlanta Rd Cumming GA 30040-2705 Ph: (770) 886-6204 | Blackwest, Llc 703 Atlanta Rd Cumming GA 30040-2705 Ph: (770) 886-6204 |
| NPI Number | 1134731045 |
|---|---|
| Provider Enumeration Date | 08/21/2020 |
| Last Update Date | 03/01/2023 |
| Certification Date | 03/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134731045 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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