Provider Demographics
NPI:1356353486
Name:BLADES, DOTTIE S (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:DOTTIE
Middle Name:S
Last Name:BLADES
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:1570 WAVERLY RD
Practice Address - Street 2:HOLSTON COUNSELING SERV
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664
Practice Address - Country:US
Practice Address - Phone:423-224-1300
Practice Address - Fax:423-224-1321
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW4548104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
184295OtherANTHEM PROF TRIGON HOLSTO
4111436OtherMAGELLAN NAVIGATOR
368130OtherMANAGED HEALTH NET
4111436OtherMAGELLAN SUMMIT
334969OtherVALUEOPTIONS GROUP
184295OtherANTHEMPREF TRIGON HOLSTON
4111436OtherMAGELLAN PINNACLE
5665594OtherFIRST HEALTH
TN3920247OtherMEDICAID CROSSO GRP
TN3987069OtherMEDICAID CROSSO
5665594OtherFIRST HEALTH
3920247Medicare ID - Type UnspecifiedGRP