Provider Demographics
NPI:1144907239
Name:BLOCK, DAVID ANDREW (LPC, SAC-IT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:BLOCK
Suffix:
Gender:M
Credentials:LPC, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 W GRAND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-6273
Mailing Address - Country:US
Mailing Address - Phone:608-207-9999
Mailing Address - Fax:
Practice Address - Street 1:136 W GRAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-6273
Practice Address - Country:US
Practice Address - Phone:608-207-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20096-130101YA0400X
WI11397-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)