Healthcare Provider Details

I. General information

NPI: 1871426460
Provider Name (Legal Business Name): ROBYN DIANE BLAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 J R DR
ELLABELL GA
31308-5464
US

IV. Provider business mailing address

95 J R DR
ELLABELL GA
31308-5464
US

V. Phone/Fax

Practice location:
  • Phone: 317-833-5495
  • Fax:
Mailing address:
  • Phone: 317-833-5495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010236
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011301A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: