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General NPI Number Information
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NPI Number | 1386439875
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Entity Type | Individual
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Provider Name | JOSHUA DAVID BLACKBURN MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 739 BLUFF CITY HWY STE 5
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City | BRISTOL
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State | TN
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Zip | 37620-4637
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Country | US
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Telephone | 423-588-0867
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Fax |
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Provider Business Mailing Address
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Address Line | 601 VIRGINIA AVE
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City | BRISTOL
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State | TN
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Zip | 37620-3934
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Country | US
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Telephone | 423-588-0867
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5409
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701014671
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License Number State | VA
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