Provider Demographics
NPI:1033879218
Name:BLAKELY, KRISTINA HANSEN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:HANSEN
Last Name:BLAKELY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 WINDY KNOLL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22802
Mailing Address - Country:US
Mailing Address - Phone:540-421-9552
Mailing Address - Fax:540-434-0132
Practice Address - Street 1:64 WEST WATER ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801
Practice Address - Country:US
Practice Address - Phone:540-212-9490
Practice Address - Fax:540-434-0132
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty