Healthcare Provider Details

I. General information

NPI: 1386439875
Provider Name (Legal Business Name): JOSHUA DAVID BLACKBURN MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 BLUFF CITY HWY STE 5
BRISTOL TN
37620-4637
US

IV. Provider business mailing address

601 VIRGINIA AVE
BRISTOL TN
37620-3934
US

V. Phone/Fax

Practice location:
  • Phone: 423-588-0867
  • Fax:
Mailing address:
  • Phone: 423-588-0867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014671
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5409
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: