Healthcare Provider Details

I. General information

NPI: 1568105468
Provider Name (Legal Business Name): LINCOLN WILLIAM BLACKWELL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 CONSTITUTION DR STE 106
EXTON PA
19341-1149
US

IV. Provider business mailing address

760 CONSTITUTION DR STE 106
EXTON PA
19341-1149
US

V. Phone/Fax

Practice location:
  • Phone: 484-699-8392
  • Fax: 484-275-2471
Mailing address:
  • Phone: 484-699-8392
  • Fax: 484-275-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC019953
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: