Healthcare Provider Details

I. General information

NPI: 1518994680
Provider Name (Legal Business Name): DEBORAH S BLANCHARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 02/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 WHEELER RD STE 100
AUGUSTA GA
30909-6550
US

IV. Provider business mailing address

3633 WHEELER RD STE 100
AUGUSTA GA
30909-6550
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-0252
  • Fax: 706-364-0269
Mailing address:
  • Phone: 706-364-0252
  • Fax: 706-364-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC001766
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: