Healthcare Provider Details

I. General information

NPI: 1871139790
Provider Name (Legal Business Name): JAMES ROLAND BLUCHER LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10545 JASON LN
COLUMBIA MD
21044-2212
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 410-997-5035
  • Fax:
Mailing address:
  • Phone: 410-933-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC1134
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: