Provider Demographics
NPI:1518613900
Name:BLAIR, STEPHEN (SUDP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:BLAIR
Suffix:
Gender:M
Credentials:SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1221 FRASER ST STE E101
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-5844
Mailing Address - Country:US
Mailing Address - Phone:360-714-8180
Mailing Address - Fax:360-715-2915
Practice Address - Street 1:1221 FRASER ST STE E101
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98229-5844
Practice Address - Country:US
Practice Address - Phone:360-714-8180
Practice Address - Fax:360-715-2915
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61167092101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP61167092OtherSUBSTANCE USE DISORDER PROFESSIONAL