Provider Demographics
NPI:1184134785
Name:BLAKESLEY, THERESA (PHD)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:BLAKESLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 CORNERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7411
Mailing Address - Country:US
Mailing Address - Phone:315-573-5244
Mailing Address - Fax:
Practice Address - Street 1:213 CORNERSTONE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7411
Practice Address - Country:US
Practice Address - Phone:315-573-5244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32533103TC0700X
SC1774103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical