Healthcare Provider Details

I. General information

NPI: 1053360263
Provider Name (Legal Business Name): PSYCHIATRIC ASSOCIATES OF THE SHENANDOAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SHENANDOAH VILLAGE DRIVE SUITE 124
WAYNESBORO VA
22980
US

IV. Provider business mailing address

920 SHENANDOAH VILLAGE DRIVE SUITE 124
WAYNESBORO VA
22980
US

V. Phone/Fax

Practice location:
  • Phone: 540-932-7800
  • Fax: 540-932-7191
Mailing address:
  • Phone: 540-932-7800
  • Fax: 540-932-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateVA

VIII. Authorized Official

Name: ROBERT H BLINN
Title or Position: SECRETARY TREASURER OWNER
Credential: PHD
Phone: 504-932-7800