Healthcare Provider Details

I. General information

NPI: 1346662301
Provider Name (Legal Business Name): BLAKE HASTINGS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 22ND ST
RICHMOND VA
23223-7020
US

IV. Provider business mailing address

200 N 22ND ST
RICHMOND VA
23223-7020
US

V. Phone/Fax

Practice location:
  • Phone: 804-644-9590
  • Fax: 804-649-2151
Mailing address:
  • Phone: 804-644-9590
  • Fax: 804-649-2151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005695
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: