Provider Demographics
NPI:1467541706
Name:BLONDINO, GEORGE L JR (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:L
Last Name:BLONDINO
Suffix:JR
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4726
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-0726
Mailing Address - Country:US
Mailing Address - Phone:434-237-9450
Mailing Address - Fax:434-237-9454
Practice Address - Street 1:100 COPLEY PL
Practice Address - Street 2:SUITE B
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2435
Practice Address - Country:US
Practice Address - Phone:434-237-9450
Practice Address - Fax:434-237-9454
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002567101YP2500X
VA0717000495106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist