Provider Demographics
NPI:1548951734
Name:BLEVINS, GEORGE ALAN (PC)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ALAN
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4737
Mailing Address - Country:US
Mailing Address - Phone:202-577-7894
Mailing Address - Fax:
Practice Address - Street 1:30 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4737
Practice Address - Country:US
Practice Address - Phone:202-577-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral