Healthcare Provider Details

I. General information

NPI: 1134829617
Provider Name (Legal Business Name): CAITLIN BLACKMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E MARKET ST STE F
LEESBURG VA
20176-4173
US

IV. Provider business mailing address

43459 POSTRAIL SQ
ASHBURN VA
20147-4632
US

V. Phone/Fax

Practice location:
  • Phone: 703-493-0467
  • Fax:
Mailing address:
  • Phone: 703-434-2009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704016973
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: