MEDICARE: MS. KERI BLONSKI LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701011457	VA

General Provider Information

NPI Number	:	1760100093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERI BLONSKI LPC

Provider Business Mailing Address
First Line	:	108 DUNCRAIG DR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-3335
Country	:	US
Telephone Number	:	434-473-6955
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 ALMEDA AVE STE 110
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23513-2448
Country	:	US
Telephone Number	:	434-237-9450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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