Healthcare Provider Details

I. General information

NPI: 1164179594
Provider Name (Legal Business Name): MEREDITH JUNE BLACKBURN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 03/06/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD
ASHEVILLE NC
28805-2576
US

IV. Provider business mailing address

6 BARNES RD
ASHEVILLE NC
28803-1807
US

V. Phone/Fax

Practice location:
  • Phone: 828-298-7911
  • Fax:
Mailing address:
  • Phone: 312-720-7828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: