Individual
MS. MARY CLAYTON BLACKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
150 LINDEN AVE, LYNCHBURG, VA 24503-2010
(434) 384-3131
Mailing address
1541 CLUB DR, LYNCHBURG, VA 24503-2556
(434) 384-8470
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701002858
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
082329M
OPTIMA/SENTARA
VA
01
—
164584
ANTHEM
VA
Enumeration date
08/11/2006
Last updated
07/08/2007
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