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General NPI Number Information
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NPI Number | 1841201852
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Entity Type | Individual
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Provider Name | MARY CLAYTON BLACKWELL LPC
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Gender | Female
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 150 LINDEN AVE
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City | LYNCHBURG
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State | VA
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Zip | 24503-2010
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Country | US
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Telephone | 434-384-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 1541 CLUB DR
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City | LYNCHBURG
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State | VA
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Zip | 24503-2556
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Country | US
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Telephone | 434-384-8470
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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 | 0701002858
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License Number State | VA
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