Healthcare Provider Details

I. General information

NPI: 1598462392
Provider Name (Legal Business Name): SAGEN LYNAE BLACKWELL PHD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2023
Last Update Date: 02/13/2023
Certification Date: 02/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 ELECTRIC RD STE 425
CAVE SPRING VA
24018-4563
US

IV. Provider business mailing address

4767 WESTVALE RD NE
ROANOKE VA
24019-5873
US

V. Phone/Fax

Practice location:
  • Phone: 540-206-2385
  • Fax:
Mailing address:
  • Phone: 864-706-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: