Provider Demographics
NPI:1366512881
Name:BLACKWOOD, LYNN CARSON JR (PHD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:CARSON
Last Name:BLACKWOOD
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200B MILNWOOD RD
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-2817
Mailing Address - Country:US
Mailing Address - Phone:434-315-8813
Mailing Address - Fax:434-315-5913
Practice Address - Street 1:200B MILNWOOD RD
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2817
Practice Address - Country:US
Practice Address - Phone:434-315-8813
Practice Address - Fax:434-315-5913
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001049103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical