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Provider Information for 1457057358


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CHARLOTTE E BLANDING Ed.D


Sex: Female

NPI: 1457057358
Last Updated: 2023-02-01
Certification Date: 2023-02-01

Details

NameValue
NPI1457057358
Enumeration Date2023-02-01
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 103 CENTURY 21 DR STE 201
JACKSONVILLE, FL 32216-9295
United States

Phone: 904-872-8068 | Fax:
 
Primary Practice Address 10959 SAWTOOTH OAK CT
JACKSONVILLE, FL 32218-6997
United States

Phone: 904-240-8633 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 101YM0800X - Counselor - Mental HealthFLMH17180