Provider Demographics
NPI:1417178427
Name:BLAIR, DIONISA EUGENIA (BS)
Entity Type:Individual
Prefix:MS
First Name:DIONISA
Middle Name:EUGENIA
Last Name:BLAIR
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 TOWN HOLLOW ROAD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-0000
Mailing Address - Country:US
Mailing Address - Phone:276-963-3554
Mailing Address - Fax:276-963-4653
Practice Address - Street 1:4959 DRY FORK ROAD
Practice Address - Street 2:
Practice Address - City:ROCKY GAP
Practice Address - State:VA
Practice Address - Zip Code:24366-0000
Practice Address - Country:US
Practice Address - Phone:304-920-4785
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YA0400X101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)