# FAIRLANE COUNSELING ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Thriveworks Chesterfield
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568881084
- **Authorized official:** MS. CHRISTINA LEE BLAYLOCK LCSW (OWNER)
- **Authorized official phone:** (804) 419-4122

## Contact information

- **Practice address:** 9846 LORI RD., STE 201, CHESTERFIELD, VA 23832
- **Practice address phone:** (804) 419-4122
- **Practice address fax:** (804) 419-4122
- **Mailing address:** 9846 LORI RD., STE 201, CHESTERFIELD, VA 23832
- **Mailing address phone:** (804) 419-4122
- **Mailing address fax:** (804) 419-4122

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 0904003316 | VA | Yes |

## Other

- **Enumeration date:** 04/11/2014
- **Last updated:** 01/15/2015