Provider Demographics
NPI:1144391681
Name:BLACKBURN, CHARLES F (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 S MIAMI BLVD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-5798
Mailing Address - Country:US
Mailing Address - Phone:919-261-6349
Mailing Address - Fax:919-572-0004
Practice Address - Street 1:2310 S MIAMI BLVD
Practice Address - Street 2:SUITE 132
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-5798
Practice Address - Country:US
Practice Address - Phone:919-261-6349
Practice Address - Fax:919-572-0004
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional