Healthcare Provider Details

I. General information

NPI: 1336201383
Provider Name (Legal Business Name): WILLIAM DALE BLANTON LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DALE BLANTON LPC

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 LINDSEY LN STE C
SAINT MARYS GA
31558-1725
US

IV. Provider business mailing address

88 LINDSEY LN STE C
SAINT MARYS GA
31558-1725
US

V. Phone/Fax

Practice location:
  • Phone: 912-825-8488
  • Fax: 912-341-6794
Mailing address:
  • Phone: 912-322-5791
  • Fax: 912-341-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC003042
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC003042
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: