MEDICARE: JOSEPH WARD BLANCHARD LCAS, M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-21259	NC

General Provider Information

NPI Number	:	1215326269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH WARD BLANCHARD LCAS, M.A.

Provider Business Mailing Address
First Line	:	5200 PARK RD STE 200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3650
Country	:	US
Telephone Number	:	252-216-9374
Fax Number	:	704-731-0916

Provider Business Practice Location Address
First Line	:	8100 SIDRAS CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-2748
Country	:	US
Telephone Number	:	252-216-9374
Fax Number	:	704-731-0916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	01/14/2015

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