Provider Demographics
NPI:1922844588
Name:BLANKENSHIP, KIRK M (MDIV)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:M
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24833
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114-4833
Mailing Address - Country:US
Mailing Address - Phone:336-309-5181
Mailing Address - Fax:
Practice Address - Street 1:220 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3214
Practice Address - Country:US
Practice Address - Phone:336-309-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral