Provider Demographics
NPI:1356150544
Name:WEST, BLAYNE COLEY (LPC)
Entity type:Individual
Prefix:
First Name:BLAYNE
Middle Name:COLEY
Last Name:WEST
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 1:115 OLD CARTERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-2788
Mailing Address - Country:US
Mailing Address - Phone:770-235-7506
Mailing Address - Fax:
Practice Address - Street 1:115 OLD CARTERSVILLE RD
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-2788
Practice Address - Country:US
Practice Address - Phone:770-235-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008157106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist