Provider Demographics
NPI:1093279846
Name:BLEVINS, GRETCHEN ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ANNE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:ANNE
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-1137
Mailing Address - Country:US
Mailing Address - Phone:276-964-6702
Mailing Address - Fax:276-964-0292
Practice Address - Street 1:196 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-1137
Practice Address - Country:US
Practice Address - Phone:276-964-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008138101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional