Provider Demographics
NPI:1235153263
Name:BLACKWELL, SUSAN CORBETT (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CORBETT
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7001 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3065
Mailing Address - Country:US
Mailing Address - Phone:540-272-6431
Mailing Address - Fax:703-754-9168
Practice Address - Street 1:7521 VIRGINIA OAKS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3831
Practice Address - Country:US
Practice Address - Phone:540-272-6431
Practice Address - Fax:703-754-9168
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003055101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA084592OtherSENTARA
VA5411807Medicaid
VA116527OtherANTHEM
VA289741OtherMAMSI