Provider Demographics
NPI:1992362768
Name:BLANKENSHIP, PERRY MASON (LPC)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:MASON
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6252 DAWES DR
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-7147
Mailing Address - Country:US
Mailing Address - Phone:304-923-0449
Mailing Address - Fax:
Practice Address - Street 1:4687 POPLAR GAP RD.
Practice Address - Street 2:
Practice Address - City:GLEN FORK
Practice Address - State:WV
Practice Address - Zip Code:25845
Practice Address - Country:US
Practice Address - Phone:304-923-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional