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General NPI Number Information
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NPI Number | 1497413405
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Entity Type | Individual
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Provider Name | KATHRYN BLUNT LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 217 E MAIN ST.
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City | WISE
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State | VA
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Zip | 24293
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Country | US
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Telephone | 276-298-5034
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Fax |
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Provider Business Mailing Address
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Address Line | 745 WOOD AVE E
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City | BIG STONE GAP
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State | VA
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Zip | 24219-3023
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Country | US
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Telephone | 423-967-9867
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904013477
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License Number State | VA
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