Provider Demographics
NPI:1720444755
Name:BLANKENSHIP, RICHARD (LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
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 1:9 DUNWOODY PARK
Mailing Address - Street 2:SUITE 136
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-7407
Mailing Address - Country:US
Mailing Address - Phone:770-744-5055
Mailing Address - Fax:
Practice Address - Street 1:9 DUNWOODY PARK
Practice Address - Street 2:SUITE 136
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7407
Practice Address - Country:US
Practice Address - Phone:770-744-5055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional