Healthcare Provider Details

I. General information

NPI: 1285322602
Provider Name (Legal Business Name): MARCI BLANDA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCI JUSTICE LICSW

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 03/18/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 US HIGHWAY 90
DAPHNE AL
36526-9512
US

IV. Provider business mailing address

7170 US 90
DAPHNE AL
36526-6091
US

V. Phone/Fax

Practice location:
  • Phone: 251-517-5800
  • Fax:
Mailing address:
  • Phone: 251-517-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18797
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4240C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: