Provider Demographics
NPI:1598462392
Name:BLACKWELL, SAGEN LYNAE (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:SAGEN
Middle Name:LYNAE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4767 WESTVALE RD NE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-5873
Mailing Address - Country:US
Mailing Address - Phone:864-706-6710
Mailing Address - Fax:
Practice Address - Street 1:3959 ELECTRIC RD STE 425
Practice Address - Street 2:
Practice Address - City:CAVE SPRING
Practice Address - State:VA
Practice Address - Zip Code:24018-4563
Practice Address - Country:US
Practice Address - Phone:540-206-2385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional