Healthcare Provider Details

I. General information

NPI: 1639296908
Provider Name (Legal Business Name): KRISTEN A BLANCHARD B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N ORANGE ST 2ND FLOOR
WILMINGTON DE
19801-2296
US

IV. Provider business mailing address

625 N ORANGE ST 2ND FLOOR
WILMINGTON DE
19801-2296
US

V. Phone/Fax

Practice location:
  • Phone: 302-656-4044
  • Fax: 302-656-3439
Mailing address:
  • Phone: 302-656-4044
  • Fax: 302-656-3439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: