Healthcare Provider Details

I. General information

NPI: 1720444755
Provider Name (Legal Business Name): RICHARD BLANKENSHIP LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 DUNWOODY PARK SUITE 136
ATLANTA GA
30338-7407
US

IV. Provider business mailing address

9 DUNWOODY PARK SUITE 136
ATLANTA GA
30338-7407
US

V. Phone/Fax

Practice location:
  • Phone: 770-744-5055
  • Fax:
Mailing address:
  • Phone: 770-744-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3121
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: