Individual ProviderMary Clayton BlackwellCounselorBehavioral Health & Social Service ProvidersPractice Address150 Linden Ave, Lynchburg, VA 24503-2010(434) 384-3131(434) 384-8470PECOS EnrollmentBased on the most recent information from CMS, provider Mary Clayton Blackwell does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1841201852Provider TypeIndividualFull NameBlackwell, Mary ClaytonTitleMs.CredentialLPCGenderFemaleSole ProprietorYesEnumeration Date8/11/2006Last Updated7/8/2007Contact InformationPractice LocationPractice Address150 Linden Ave, Lynchburg, VA 24503-2010Phone(434) 384-3131FaxUnlisted FaxMailing LocationMailing Address1541 Club Dr, Lynchburg, VA 24503-2556Phone(434) 384-8470FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YP2500XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense0701002858VirginiaProvider IdentifiersIDDescriptionIssuerID164584DescriptionOtherIssuerANTHEMVirginiaID082329MDescriptionOtherIssuerOPTIMA/SENTARAVirginia