Provider Demographics
NPI:1841408036
Name:BLACKBURN, CONSTANCE EILEEN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:EILEEN
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22001 ANNS CHOICE WAY
Mailing Address - Street 2:
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974-3347
Mailing Address - Country:US
Mailing Address - Phone:215-957-1157
Mailing Address - Fax:
Practice Address - Street 1:22001 ANNS CHOICE WAY
Practice Address - Street 2:
Practice Address - City:WARMINSTER
Practice Address - State:PA
Practice Address - Zip Code:18974-3347
Practice Address - Country:US
Practice Address - Phone:215-957-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002738106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist