| Doctor Name: | MR. JODY LYNN BLEVINS |
| NPI Number: | 1063506764 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LPC |
| License Number: | 5386 |
| Business Practice Address: | 507 Courthouse Dr Wilkesboro, NC - 286972926 |
| Business Phone Number: | 3366673333 |
| Business Fax Number: | 3366678749 |
| Mailing Address: | 507 Courthouse Dr, WILKESBORO |
| State: | NC |
| Postal Code: | 286972926 |
| Phone Number: | 3366673333 |
| Fax Number: | 3366678749 |
| NPI Enumeration Date: | 10/03/2006 |
| NPI Last Update Date: | 09/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 5386 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |