Provider Demographics
NPI:1740442862
Name:BLACKWELL, MARTHA LEA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LEA
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 STANLEY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-9748
Mailing Address - Country:US
Mailing Address - Phone:757-435-6658
Mailing Address - Fax:
Practice Address - Street 1:220 STANLEY DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-9748
Practice Address - Country:US
Practice Address - Phone:757-435-6658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY9351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical