Provider Demographics
NPI:1407213135
Name:BLACKSMITH, GINGER (LPC)
Entity type:Individual
Prefix:MRS
First Name:GINGER
Middle Name:
Last Name:BLACKSMITH
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 1:19 BUSINESS PARK DR STE 5
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9286
Mailing Address - Country:US
Mailing Address - Phone:501-581-7703
Mailing Address - Fax:501-204-6004
Practice Address - Street 1:19 BUSINESS PARK DR STE 5
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9286
Practice Address - Country:US
Practice Address - Phone:501-581-7703
Practice Address - Fax:501-204-6004
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1701223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty