Provider Demographics
NPI:1902937139
Name:SKIDMORE-BLEVINS, CYNTHIA JANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:JANE
Last Name:SKIDMORE-BLEVINS
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 1:400 ROANOKE ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3139
Mailing Address - Country:US
Mailing Address - Phone:540-381-6215
Mailing Address - Fax:540-381-6216
Practice Address - Street 1:400 ROANOKE ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3139
Practice Address - Country:US
Practice Address - Phone:540-381-6215
Practice Address - Fax:540-381-6216
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005059101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty