Provider Demographics
NPI:1033219605
Name:BLANKENSHIP, JENNIFER LENORE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LENORE
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24212-0985
Mailing Address - Country:US
Mailing Address - Phone:276-628-2510
Mailing Address - Fax:276-628-9594
Practice Address - Street 1:335 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2905
Practice Address - Country:US
Practice Address - Phone:276-628-2510
Practice Address - Fax:276-628-9594
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040039211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7320136OtherAETNA
VA008918911Medicaid
VA513306OtherVALUE OPTIONS
VA2037889OtherCIGNA
VA292218000OtherMAGELLAN
VA256926OtherANTHEM
VA00V951J01Medicare PIN