Provider Demographics
NPI:1972175974
Name:BLAYLOCK, ROCKELLA (LPC)
Entity Type:Individual
Prefix:
First Name:ROCKELLA
Middle Name:
Last Name:BLAYLOCK
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 1:421 DOGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-9232
Mailing Address - Country:US
Mailing Address - Phone:484-575-6552
Mailing Address - Fax:
Practice Address - Street 1:421 DOGWOOD CT
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-9232
Practice Address - Country:US
Practice Address - Phone:484-575-6552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011459101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health