Healthcare Provider Details

I. General information

NPI: 1033879218
Provider Name (Legal Business Name): KRISTINA HANSEN BLAKELY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 11/29/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 WEST WATER ST
HARRISONBURG VA
22801
US

IV. Provider business mailing address

134 WINDY KNOLL DRIVE
ROCKINGHAM VA
22802
US

V. Phone/Fax

Practice location:
  • Phone: 540-212-9490
  • Fax: 540-434-0132
Mailing address:
  • Phone: 540-421-9552
  • Fax: 540-434-0132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011108
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: