Provider Demographics
NPI:1508010182
Name:BLACKSTONE, CARLY B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:B
Last Name:BLACKSTONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 S GLEBE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1655
Mailing Address - Country:US
Mailing Address - Phone:703-521-6004
Mailing Address - Fax:701-521-6342
Practice Address - Street 1:46 S GLEBE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1655
Practice Address - Country:US
Practice Address - Phone:703-521-6004
Practice Address - Fax:701-521-6342
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003993103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical