Healthcare Provider Details

I. General information

NPI: 1992632053
Provider Name (Legal Business Name): ANNIE LOU B BLAKEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1971
US

IV. Provider business mailing address

850 SOUTHAMPTON AVE FL 4
NORFOLK VA
23510-1021
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-5706
  • Fax: 757-668-8559
Mailing address:
  • Phone: 757-668-5706
  • Fax: 757-668-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019585
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: