Provider Demographics
NPI:1386439875
Name:BLACKBURN, JOSHUA DAVID (MA, LPC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:BLACKBURN
Suffix:
Gender:
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-3934
Mailing Address - Country:US
Mailing Address - Phone:423-588-0867
Mailing Address - Fax:
Practice Address - Street 1:739 BLUFF CITY HWY STE 5
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4637
Practice Address - Country:US
Practice Address - Phone:423-588-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5409101YM0800X
VA0701014671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health