Healthcare Provider Details

I. General information

NPI: 1831927334
Provider Name (Legal Business Name): CHARITY J BLAIR CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062B W MERCURY BLVD SUITE 1062B,
HAMPTON VA
23666
US

IV. Provider business mailing address

91 28TH ST APT C2
NEWPORT NEWS VA
23607-3927
US

V. Phone/Fax

Practice location:
  • Phone: 757-644-0644
  • Fax:
Mailing address:
  • Phone: 843-318-9971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202012135
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: