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General NPI Number Information
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NPI Number | 1013486208
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Entity Type | Individual
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Provider Name | TERESA ELAINE BLACKBURN LPC
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Gender | Female
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 200 HIGH TOWER BLVD STE 306
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City | PITTSBURGH
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State | PA
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Zip | 15205-1135
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Country | US
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Telephone | 740-461-4829
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Fax |
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Provider Business Mailing Address
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Address Line | 136 S AVALON DR
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City | WINTERSVILLE
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State | OH
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Zip | 43953-3706
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Country | US
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Telephone | 740-461-4829
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC010795
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License Number State | PA
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